There's no way to sugarcoat a discussion about the issue that all of us must one day face: the end of life. Yet it is beneficial for family members to have their healthcare wishes planned in advance of any medical emergency. When a patient's spouse or child is faced with making tough treatment decisions because the patient is unable to, a document called an advance directive will help bring some clarity to a frightening and confusion situation.
An advance directive is a durable power of attorney for healthcare and living will. It provides caregivers with a person's decisions regarding issues such as life support, artificial nutrition or hydration, and non-beneficial treatment at the end of life.
"An advance directive helps both the family and the physician by providing the essence of a patient's wishes for their end of life," says Kathleen DeLoach Benton, Director of Clinical Ethics at St. Joseph's/Candler.
Benton advises people to choose someone that they trust to become their health care agent-the person who will make healthcare decisions for them when they cannot. A copy of the advance directive should be given to the health care agent as well as a person's physician's office and the hospital of his or her choice.
The difference between an advance directive and a DNR is not always clear to patients.
"Some patients may think that if they decide they do not want aggressive care at end of life, and write this into their advance directive, that they will not be treated if they have a cardiac or respiratory arrest," Benton says. "They may think this makes them a DNR. Likewise, if they wish to be a DNR to avoid being put on life support even if they are not deemed terminal by a medical doctor, they may think completing this document will uphold those wishes. This is not the case."
"An advance directive and a DNR order are separate documents," Benton explains. "The advance directive is written and signed by the patient. A DNR is an order issued by a doctor and consented for by the patient or surrogate."
Savannah resident Windell Smith already had his advance directive on file, but made a call to Benton after a hospital stay when he learned that the wishes specific to life support would not be honored unless a DNR order was written by his admitting physician.
"I was unaware of the requirement," Smith recalls. "Mrs. Benton explained that a DNR request would not be honored during surgery due to the need to assess the patient after anesthesiology had been discontinued."
If a patient desires a DNR, the request will be reinstated when the patient returns from the procedure. Still, the uncertainty of the experience left Smith with a desire to tell others about the importance of creating an advance directive and the need to ask questions about its purpose.
"It's important for individuals to know the differences between the various documents relating to their wishes concerning their health care in the event they are unable to communicate those needs," Smith says. "The documents also inform family members and health care professionals of the patient's wishes, making it easier for others to carry out those wishes."