Be Very Careful With a Do Not Resuscitate Order

By Craig Watson

Harold was an 80-year-old bachelor, a former fighter pilot, a colorful and fun loving guy. Unfortunately, he suffered a stroke. He lived alone so it was 24 hours before he made it to a hospital. So by then, the stroke damage had become permanent. He had aphasia, which means he was able to start the first few words of a sentence but couldn’t finish it. His mind was otherwise mentally alert but he had to learn how to cope with his new communication disability and needed to enter a nursing home.

There are far more female residents in nursing homes than men. For Harold, this meant there were plenty of potential girlfriends. He was quite the playboy and actually enjoyed living in the nursing home because he had more friends as compared to living alone.

Harold had a niece who began looking after him after he entered the nursing home. The nursing home asked if Harold wanted to sign a Do Not Resuscitate (DNR) order. Without checking with an elder law attorney, his niece thought that was a good idea and had him sign the DNR. The nursing home provided minimal counseling regarding whether he should sign it. Several weeks later, he began choking after lunch and because he had a DNR, the nursing home provided no assistance and he died.

Many people misunderstand the difference between a Directive to Physicians (also known as a Living Will) and a DNR. A Directive to Physicians states that the person does not want to continue life maintaining treatment if a doctor certifies that he either is in a persistent vegetative state or suffers from a terminal condition that will result in death in the near future. The second condition precedent is that the patient is unable to make a decision to discontinue life-sustaining treatment. The patient makes known in the document that he doesn’t want to continue life-sustaining treatment in those circumstances. All of us should consider signing a Directive to Physicians.

On the other hand, a DNR states that the principal does not want to be resuscitated, regardless of the circumstance. The DNR is not limited to situations where the Principal is suffering from an immediately terminal condition and unable to make a decision regarding discontinuation of treatment. The DNR basically means lifesaving treatment will be withheld.

No one should sign a DNR unless they are in chronic severe pain, suffer from end stage dementia or otherwise suffer from some other severe condition that limits them to a terrible quality of life.

Harold was mentally alert and enjoying life. He was not demented and certainly wasn’t suffering from any painful condition. But because he had a DNR, the nursing home followed the written instructions therein and made no attempt to resuscitate him. He should not have had a DNR. Harold should have had a Directive to Physicians. The practical effect of the way it works is that if the person is found unconscious, he will immediately be rushed to an emergency room to determine what’s wrong and what can be done. After running tests, etc., if it is determined that there is no hope, the family will be able to remove life-sustaining treatment such as feeding tubes, a respirator, dialysis, etc. The Directive to Physicians designates an agent to make such a decision if the patient is incapacitated. The fact that the patient has made his wishes known in advance serves as a great comfort for a grieving family. It takes the pressure off his family because he made the decision and spared them from it.

The federal government has mandated that elderly patients should be offered the opportunity to sign a DNR and a Directive to Physicians when they are admitted to a medical facility. One should be very careful about signing a DNR. These issues are literally about life and death. It is certainly worth it to bring your family to see an experienced Elder Law attorney to discuss these issues before a serious mistake occurs.

Craig Watson’s law practice focuses on Estate Planning, Probate, Guardianship and Elder Law. He is Board Certified in Elder Law by the National Elder Law Foundation as recognized by the Texas Board of Legal Specialization. Formerly a CPA, he has 25 years of experience. Call 903-813-8500 or go to www.craigwatsonlaw.com.