Do Not Resuscitate Orders Being Placed Without Patient Consent?

Motion Blur Stretcher Gurney Patient Hospital Emergency

All of us can be lulled into believing we’ve got plenty of time, until something unexpected happens. Whether it’s a car accident, a heart attack, a fire, or a stroke, those who procrastinated and didn’t plan in advance often kick themselves for not taking action sooner.

Let’s take, for example, Michelle Singletary, a Washington Post reporter whose mother was in a house fire and was in critical condition. When working with health professionals, Ms. Singletary and her sister experienced a great deal of stress because her mother never prepared any Incapacity Planning documents, indicating her wishes for medical care or life-prolonging procedures.

What if you were in a similar situation, and the decision to pull the plug was made for you? Wouldn’t it be awful if it wasn’t what you intended for yourself or your loved one? Well, that is what is happening in the UK. In fact, tens of thousands of patients are having “do not resuscitate” orders imposed without their families’ consent.

In England, hospitals are failing to tell relatives that they do not intend to attempt potentially lifesaving techniques to save their loved ones, according to the Royal College of Physicians. An audit of 9,000 dying patients found that one in five families were not informed of the plans – equivalent to 40,000 patients a year. In 16% of cases, the study found there was no record of a conversation with the patient about the order, and no planning documents were located.

Advance Directives Are a Must!

Could hospitals take important decisions like this into their own hands in the U.S.? Maybe or maybe not. To protect yourself, however, and guarantee that this won’t happen to you or a loved one, Advance Directives are imperative.

An Advance Medical Directive is the document that give you control over your medical care if you’re unable to speak for yourself. In your Advance Directive, you designate someone to make health care decisions for you if you can’t, and you also give guidance on the types of treatments you would or would not want.

Based on her experience with her mother, Michelle Singletary emphasizes that it is important to meet with an attorney who knows about changes in the law and specific documents that must be signed. She said that “I’m a frugal person but this is not the time to be a penny pincher.” According to Ms. Singletary, “If you care about those who will handle things for you in case you become incapacitated, help them now. Do it if you have dependent children or someone depending on you financially. Do it for the people you will leave behind.”

An Advance Medical Directive (which should include a Long-Term Care Directive and Post-Mortem Directive) is one component of an overall Incapacity Plan.  The other documents that are part of an Incapacity Plan are:

  • A properly-drafted Durable General Power of Attorney that contains complete Medicaid asset protection powers, including full gifting and full trust creation and termination powers.
  • A HIPAA Authorization.
  • A Special Power of Attorney for each piece of Real Estate that you own.
  • A Lifestyle Care Plan to ensure you get the best care if you wind up needing long-term care and you are unable to speak for yourself.

For more details on why you should plan for incapacity and details on some of the types of documents you need, please read our blog article, “Are You Prepared For Incapacity?”

When you have Advance Directives, Make Sure Hospitals Can Access Them
At the Farr Law Firm, we enroll our clients in the DocuBank electronic registry to ensure that their advance directives are always available at the hospital. Now, this is especially important, as it was recently discovered that doctors cannot easily get hold of their patients’ advance directives at the hospital, even in an emergency, according to a news report in USA Today/Kaiser Health News.

Ironically, electronic medical records, which are supposed to help find patient information, actually create their own problems, the article explains. One problem is that different medical records are incompatible, meaning that different hospitals can’t share your Advance Medical Directive, and even the same hospital often can’t share your Advance Medical Directive between different departments of the same hospital. So, for example, if your Advance Medical Directive is available in the emergency department and you need to be moved to cardiology, it might not be accessible there.

Another problem is that it could take a while to find your Advance Medical Directive because most electronic health records aren’t set up to store one. “If [medical staff are] not able to access the advance directive quickly and easily, they’re honestly likely not to use it,” says Torrie Fields, senior program manager for palliative care at Blue Shield of California.

In addition, the article affirms that patients frequently (and understandably) forget to bring their advance directives with them.

Lack of availability of your Advance Medical Directive can be an especially big problem in the hospital, where it’s extremely important that your doctors and loved ones have instant access to these documents and therefore to your wishes. These problems are precisely why we register the Advance Medical Directives of our clients with DocuBank. We’ve heard too many horror stories, and we want to ensure that your doctors and loved ones can immediately obtain your Advance Medical Directive so that you can get the best care — the care that you desire.

What Are You Waiting For?

To ensure your wishes are met, it is important to start your planning while your mind is still sharp and your judgment is sound, so you are prepared in advance if a crisis occurs. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact us for an initial consultation:

Fairfax Estate Planning and Incapacity Planning: 703-691-1888
Fredericksburg Estate Planning and Incapacity Planning: 540-479-1435
Rockville Estate Planning and Incapacity Planning: 301-519-8041
DC Estate Planning and Incapacity Planning: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.