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Living Wills & DNR: Is Patient Safety Compromised?

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More and more people are preparing living wills and DNR (do not resuscitate) orders, both of which are created to assist patients in the event of a medical emergency if they are unable to speak for themselves. You should be aware that laws and rules regarding preparation of these and other documents pertaining to health care issues vary from state to state, so it is wise to consult an attorney and your health care provider prior to preparing and/or signing anything.

A living will is a document that you can prepare on your own or with the assistance of an attorney or health care professional. This document lists the medical treatment you wish in the event that you are in terminally ill or are in a permanently unconscious state and cannot communicate with your health care provider, and can also name an individual to act in your stead to ensure that your wishes are carried out.

A DNR order is actually prepared by a physician based upon the patient’s current health situation, the physician’s advice and information provided regarding the patient’s wishes. The DNR order tells health care providers whether they should attempt to resuscitate a patient if it should be necessary during a medical procedure or as a result of a terminal illness.

Dr. Ferdinando L Mirarchi has suggested that one problem with a living will is a lack of individualization, as these documents are generally prepared from a standard template, when an individual is also preparing other legal documents, such as their Last Will and Testament or Power of Attorney. Because the living will is more often prepared only on the advice of an attorney, it may not contain language that is conducive to assisting health care providers in determining a patient’s exact wishes. This is because they are prepared without informed consent, meaning the patient has not consulted with a physician regarding specific issues connected with their medical treatment and they may not understand all the risk and/or benefits involved with their treatment. Also, a living will can be prepared years prior to being used and, therefore, may no longer be relevant when needed.

Additionally, a patient entering the hospital without a living will, often prepares and signs a generic document, at the direction of hospital personnel, but once again, this is without informed consent and may not meet the needs of the patient and their care. Add to that the fact that most patients aren’t even really sure what they are signing, and you can see that these documents can often be misinterpreted or not adhere to the patient’s wishes.

Another issue that can arise is that many health care professionals may interpret certain terms to mean different things, especially since the language in the documents can be ambiguous. Finally, in some cases, having a living will can be interpreted as having a DNR order, when the two documents do not necessarily cover the same issues. Beyond that, some medical professionals may interpret the phrase “do not resuscitate” to mean “do not treat” when the patient may not mean that at all. A patient may not wish to be resuscitated if they are nearing death and their heart and/or breathing has stopped. However, a desire by a patient to not be kept alive in a vegetative state, is not necessarily the same thing as not wishing to have treatment that can save their life.

Special Sources To Note:

Understanding Your Living Will (Addicus Books, 2006)http://www.addicusbooks.com/show_title.cfm?isbn=1886039771

Mirarchi,Ferdinando Does a Living Will Equal a DNR? Is Patient Safety Compromised?, Journal of Emergency Medicine, Vol. 33, No.3, pp299-305, 2007.

Mirarchi, Ferdinando L “Living Wills & DNR: Is Patient Safety Compromised?”. Human Life Review. . FindArticles.com. 23 Sep. 2008. http://findarticles.com/p/articles/mi_qa3798/is_200710/ai_n24394969

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