End-of-life directives, and the efforts they direct on behalf of terminal patients, aren’t like what people see on television, a local emergency medicine and hospice physician said.
“A lot of people are confused,” said Dr. Lenora Berning, who is board-certified in both emergency medicine and hospice and palliative care. She provides hospice care for a local organization in Huntersville.
Advance directives, as such documents are called, are the DNAR, the living will and the health-care power of attorney, she said.
“Those are three really important things to have in place if a person is interested in having some say in their health care during a situation where they may be very near the end of life,” she said.
The DNAR is a medical order, signed by a physician, and it comes into play when a patient has stopped breathing and their heart has stopped beating,” Berning said.
“A DNAR is a medical order not to start chest compressions or other cardiac drugs on someone’s heart when their heart has already stopped beating, and not to put them on mechanical ventilation or artificially ventilate them when they have stopped breathing,” she said.
“A lot of people are afraid to fill out a DNAR, or a DNR, because they think that means ‘don’t treat me.’ What it actually means is that if someone is down, and their heart is not beating, they do not want a team to come in and start chest compressions, shock their heart or begin ventilating them.”
Many people believe their living will is the same as a DNAR order. That’s mistaken, she said.
“A living will includes the individual preferences on heroic measures at end-of-life care, feeding tubes, mechanical ventilation, heroic measures, dialysis,” she said. “All those types of things are in the living will. That helps to guide the physician’s decision-making during care of someone critically ill who has a low chance of recovery.”
“People often have their living will, but unless I have that in my hand, as a physician, if it’s in someone’s lock box, it doesn’t help me.
For example, consider an elderly person or someone with a terminal illness who experiences cardiac arrest. Someone calls 911, and paramedics arrive.
“This person has a living will that says they do not want heroic measures taken. A living will is not a medical order that they can follow if there is not a DNAR or a MOST form (Medical Order for Scope Treatment) in the home.”
A MOST form includes a DNAR and other life-saving and life-prolonging interventions when someone is in critical condition, she said. It includes some of the factors in a living will.
“Keep (the MOST form) in your home, in a prominent place, so anyone who is in your home knows you have the form,” she said.
Berning also stressed that a health-care power of attorney is different from an ordinary power of attorney. They are distinct legal documents, just as the living will and the DNAR are.
She strongly advises families to discuss these difficult subjects.
“Peoples preferences change, so if you’ve done a living will and you haven’t done it or looked at it for a while, you might want to look it over,” Berning said.