By Ashley Horst, Fundraising & Marketing Coordinator
For the last 13 years, I have been educating the community about the importance of an advance directive. I’ve spoken on the subject dozens of times with various groups—church groups, civic organizations, hospice volunteers and more. Each time I speak with a group, I invariably hear a version of this story:
“My dad (or other family member or friend) had a living will that said that he did not want CPR. He had a heart attack and we called 9-1-1. The paramedics came and did CPR anyway even though we told them that he didn’t want it. Why didn’t the paramedics follow his wishes?”
This is a tough scenario for everyone involved but has a pretty clear answer. A living will is not a physician’s order. The paramedics or EMTs legally have to perform CPR or provide any other life-supporting care they feel is necessary until the patient arrives at the hospital or they are ordered to stop by a physician.
Let’s dig into this a little more by backing up a bit and talk about what a living will is. A living will is a legal document in which you write down what you do or do not want regarding life support, CPR, ventilators and more. In the state of WV, a living will must be witnessed by two people who are not related to you and notarized. It is a legal document and a physician is required by law to follow the wishes expressed in your living will.
The shortcoming of a living will is that it must be interpreted by a medical doctor. This means that it will not be followed until a physician has the opportunity to read the document. This would normally happen once you arrive at the hospital and the doctor caring for you is given a copy of your living will.
So what do you do if you don’t want CPR or other life-supporting treatment before getting to the hospital?
You complete a Do Not Resuscitate order or a POST form. These are both physician’s orders and allow emergency personnel to not perform CPR if you were to die a natural death.
A Do Not Resuscitate order (commonly referred to as a DNR) is completed with you and signed by your medical doctor (or advanced practice registered nurse or physician assistant). Because it is signed by a medical doctor, it is a physician’s order and allows emergency personnel to not perform CPR in the event of cardiac or respiratory arrest. In order for emergency personnel to follow the DNR order, they must see the DNR form with the physician’s signature. At Hospice of the Panhandle, we recommend that anyone who has a completed DNR order post it on their refrigerator where it is easy to access.
A POST form is also a physician’s order that is completed by you and a medical doctor (or advanced practice registered nurse or physician assistant). Where a DNR order is specific to CPR, a POST form allows you to give more specific instructions regarding CPR, treatment options for someone who has a pulse and is breathing, and medically assisted nutrition (otherwise known as having a feeding tube). Like the DNR order, emergency personnel must see the POST form with the physician’s signature in order to not perform CPR. Similarly, we recommend anyone with a POST form keep it on their refrigerator where it is easily accessible.
Both the DNR order and the POST form will assure that you do not receive unwanted CPR if you were to die a natural death. The limitation to both of these though is that they are intended for those who are seriously ill or the frail elderly. A physician likely would not complete a DNR order or POST form for someone who is healthy, even if they don’t want CPR in the event of cardiac or respiratory arrest.
So why have a DNR order or a POST form and a living will?
Think about it this way. The POST form and DNR order cover you until you get to the hospital. Both are physician’s orders and can direct care provided by emergency services. If you are transported to the hospital, the doctor can then give orders based on directions provided in a living will. The living will generally has more detailed instructions than what can be included on a DNR order or POST form. It also supports your family and informs them of what your wishes are regarding your care.
If you have questions about living wills, DNR orders or POST forms, please call Hospice of the Panhandle at (304) 264-0406 and request a personalized resource guide. You can receive a free packet of information and speak to a social worker who can help you navigate these decisions and assure that you have the documentation in place to ensure that your wishes are followed.
Ashley Horst is the fundraising and marketing coordinator for Hospice of the Panhandle, where she has worked for the past 13 years. To find out more information about how you or a loved one can be surrounded by the compassionate care of Hospice of the Panhandle, call 304-264-0406 or go to hospiceotp.org.