Many hospitals and clinics will ask the patient or family about the existence of advanced directives when they are admitted to the hospital. In fact, some states require hospitals to do this and to offer blank documents if the patient has no advance directives. The existence of an advance directive is documented prominently in the medical chart. Also, health professionals should document any discussions with the patient about their end-of-life desires or treatment preferences in their medical record.
Physicians and health care providers are immune from civil, criminal, and disciplinary action if they follow the advanced directive statute in good faith and meet its provisions.
Do Not Resuscitate (DNR) Orders
Advanced directives are not DNR orders. DNR orders are written by doctors to indicate that a patient should not be resuscitated. The order may be written to reflect a patient's or surrogate's expressed wishes about resuscitation, or because the patient will not benefit from resuscitation. For example, for someone with a living will or durable power of attorney for health care, CPR may be appropriate if they are suffering from an acute life-threatening condition. Patients with advance directives may want aggressive treatment for potentially reversible conditions. Generally, doctors will proceed with such efforts if the patient is not suffering from a clearly terminal condition or in an irreversible coma.
Points to Remember
Advance directives only take effect when the patient loses the ability to make his or her own decisions. Before that time, the patient's current expressed wishes will be followed by health care professionals.
Advance directives do not replace active communication with patients and their families. Patients and families should always be provided appropriate and sufficient information to make informed health care decisions. Patients' expressed preferences about health care treatments should be documented as they evolve during the course of treatment.
Assessing and attending to patients' spiritual needs are important in quality end-of-life care and should be a routine part of patient care.
Quality medical care also includes providing patients with a supportive atmosphere in which to reflect on end-of-life choices and to allow their wishes to be communicated to their health care providers and to their families.