Friday, November 13, 2009

Dying Decisions – It’s a Good Thing

This may seem to be a strange blog post title, but we all know that death is part of every life. And making a decision in advance as to how you want to die and what treatments you want to receive is usually a good thing. As Elder Law Attorneys, we often are called to assist people and their families toward the end of their life. We have found that families that have had the “dying discussion” with their loved one experience much less stress (caused as a result of wondering whether we’re doing the right thing) than families who have not done so.

Having the talk with your family is crucial. There is no substitute from hearing it directly from Mom or Dad or your Spouse what they want when the time comes. However, talking is not enough. You need to have signed proper legal documents that reflect your directions. In this blog post, we are going to discuss two health care documents necessary to carry out your last wishes - Private Living Will and Do Not Resuscitate (DNR) Order.

A Private Living Will is a legal document in which you can state what medical treatments or interventions you want to receive in an attempt to prolong your life. You can be specific, stating whether you want a particular treatment, or you can leave the decision up to your doctor or person that you have appointed to make health care decisions for you.

I would caution you to not be too specific or you could be “hung by the tongue”. There is an infamous case where a man stated that he did not want hydration (liquid) when he was in the process of dying. When he was later dying with cancer and was in a lot of pain, the medical team determined that they could not give him morphine to dull the pain because of his wish not to receive “hydration”.

The standard language of a Private Living Will in Arkansas states that the “attending physician” may “withhold or withdraw” treatments that only prolong the process of dying. However, most attending physicians that I have met do not want to have to make this decision. It is much better practice to also have a clause in your Private Living Will which appoints a family member as your health care surrogate. In this case, the doctor will state that the person is terminal or irreversible - then the family member can decide what actions to take, based on your written instructions and your prior discussions with them.

By comparison, a Do Not Resuscitate (DNR) Order is a written order by a patient’s attending physician that prevents CPR in the event of cardiac or respiratory arrest. Arkansas provides for recognition of DNR orders by emergency personnel such as EMS workers and hospital emergency room staff. A person can request that their doctor issue a DNR order or they can make this request in their Private Living Will.

This is not an easy issue and is not a discussion that a family wants to have. However, I will promise you that (after the fact) this is a discussion that families are very glad that they had with their loved one while they had the opportunity to do so.

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