Modern medicine has seen advancements that provide us with the opportunity to live longer, and to survive more medically catastrophic events. These advancements have come so far, that we have needed to come up with legal limitations on how we can sustain the beating heart of the human body. These adjustments and limitations come from a multitude of sources, ranging from religious and cultural, to those of comfort and practicality. The documents you will need to ensure your medical wishes are followed in the event of your incapacitation will depend on a few factors, such as your current medical conditions and your preferred style of medical care.
Figuring out if you want a DNR, POLST, or need an Advanced Care Directive (also known as a Health Care Directive or Living Will) as part of your estate plan can be confusing. There are always the “what ifs” to contend with. At The Whipple Law Group, our estate planning attorneys can walk you through all the scenarios and help you determine what is important to you. Contact us online or at 509-869-3223 to schedule a consultation and learn more about DNRs and other tools you can use in a smart, comprehensive estate plan.
What is the Advantage of a POLST Form?
A Physical Order for Life-Sustaining Treatment form (POLST) is for those with advanced disease or severe frailty. To these individuals, emergency “life-saving/preserving” measures may inadvertently cause more harm than good, to their standard of living. The POLST form is created by your medical care provider, as a set of directions to those first responders who will be on-site during any eventual emergency. This form will go hand in hand with other advanced care planning documents, such as Medical Power of Attorney or Living Will. Any emergency responders will be able to quickly review the posted POLST form and act accordingly.
Any health care directive will come into play, should the medical event lead to terminal incapacity, and will direct the type of medical care you'll receive at that time. A POLST is almost exclusively needed for those with a serious illness or advanced frailty, as its purpose is to limit the available treatment options that can be used during the emergency response, to ensure those options that are available do not cause additional harm to the individual in crisis.
What if there are No Severe Health Concerns?
Individuals without any restrictive disease or advanced frailty will receive the typical standard care procedures during emergency situations from first responders. As your body will not be otherwise additionally compromised, barring special circumstances, there is typically no reason to restrict the medical care options available to those assisting you during your medical emergency. In these situations, a set of instructions is useful in the event that you become incapacitated temporarily, or permanently.
Your set of instructions will direct your friends, family, and/or loved ones to your specific wishes. These instructions can not only be a useful tool, as they provide clear instructions of your wants, but a loving tool, as your loved ones will be saved from weighted pressures of attempting to decide or choose what they feel you would have wanted if you were not currently incapacitated. The following documents are advanced care planning documents: Power of Attorney, Living Will, Do Not Attempt Resuscitate Order.
Health Care Power of Attorney
A Health Care Power of Attorney, or medical power of attorney, is a legal document that designates who will make medical decisions on your behalf, when you are otherwise unable to do so. It is important to note that these powers can be engaged immediately, meaning that your selection can work hand in hand with your medical professionals today, or upon disability (often referred to as “springing”). It is also important to note that during this time the legal decision-making authority is never taken from you, but shared while the power of attorney is active.
Any specific directions, regarding medical care preferences, should be established in a health care directive that explicitly states your wishes and directs your health care power of attorney. Remember, powers of attorney are revocable. When you have decision-making capacity, the power of attorney may be revoked by writing a simple letter stating as such. Power of attorney is automatically ended upon the death of the principal that the document was providing legal guidance for.
In Washington, medical decision-making follows a clear hierarchy to ensure that a patient's healthcare preferences are respected. Priority is given to the individual, then to a court-appointed legal guardian with decision-making authority, followed by an individual with durable power of attorney for healthcare. If neither is available, the responsibility falls to the spouse or committed intimate relationship partner, then to the patient's adult children – all of whom must be in agreement.
This is followed by parents, and finally, adult siblings—all of whom must be in agreement as well. This hierarchy ensures that decisions are made by those who know the patient best, reflecting their values and wishes. Reach out to a compassionate, knowledgeable estate planning attorney from The Whipple Law Group and ensure that your estate plan is up to date today!
Living Will: Health Care Directive
A living will, sometimes called a health care directive, makes your wishes known as to what medical treatments or measures you want to have, if you are unable to make those decisions for yourself. This document is engaged after you have been diagnosed to be in a terminal condition or a permanent unconscious condition, meaning there is no medical expectation for you to medically improve or become conscious again.
Stating your preferences in a living will can take the burden off of loved ones and decrease stress during an emergency, or a long-term medical situation, as you've taken the decision-making out of their hands. This is especially important to remember for those who also have a medical power of attorney in place. The health care directive is a higher authority and directs the attorney-in-fact, nominated by the Power of Attorney document. Below is a list of a few of the options that would be available from when pre-determining the medical care to receive, or not receive, when declared indefinitely incapacitated:
- Nutrition
- Hydration
- CPR
- Respirator
- Intubation
- Blood Dialysis
- Blood Transfusion
Understanding Health Care Directives in Washington
Although contemplating one's own death is uncomfortable, it is an inevitable reality. An accident can happen any day. You could be diagnosed with a terminal illness. Without a plan in place for end-of-life care or medical treatment preferences in the event you become incapacitated, your family members will be forced to make those decisions, on your behalf. This can lead to conflict and feelings of guilt—an outcome you surely want to avoid.
At The Whipple Law Group, our health care directive attorney in Washington can go over these sensitive matters with you and help you devise a health care directive that mirrors your values and beliefs. Contact us at 509-869-3223 or online schedule a consultation to learn more.
What Can Advance Directives Do in Washington?
An advance directive is a set of medical instructions outlining what should be done when an individual can no longer make critical healthcare decisions on their own. While each state has its own specific forms for advance directives, many common elements are consistent.
The primary purpose of an advance directive is to ensure that a patient's healthcare wishes are clearly communicated before any medical issues arise. Some examples of advance directives include:
- Living Wills
- Do-Not-Attempt-Resuscitation (DNR/DNAR)
- Do-Not-Intubate (DNI) Instructions
- Organ donor registration
- Designation of a health care proxy, or someone else to make medical decisions on the patient's behalf
- Designation of a medical power of attorney
Advance directives spare your loved ones the emotional burden of making difficult healthcare decisions on your behalf when you are no longer able to do so. Additionally, they ensure that your medical treatment preferences are honored, preventing unwanted care while guaranteeing that the care you desire is provided.
Creating an Advance Directive in Washington
The requirements for creating advance directives vary significantly from state to state. Some states require advance directives to be highly detailed and specific, while others permit them to be more general and broader in scope. However, regardless of your location, the more precise your directives, the less room there will be for confusion. It is wise to consult with your doctor to discuss your preferences for your advance directive, and then seek advice from an attorney to ensure you complete the appropriate forms correctly.
In any event, upon creating an advance directive, you want to:
- Keep the originals in a safe, accessible place.
- Provide a copy to your doctor, health care agent, attorney, and/or loved ones.
- Be sure to log who has a copy of the directive so in case one is lost, you have a backup.
- Talk to family members about the decisions you made in the advance directive. It's good to establish boundaries and an understanding of your preferences.
- Keep with you (in your purse or wallet) and a condensed version of the directive with a note where a copy may be found - this is important for unexpected emergencies.
Changing Advance Directives in Washington
Every few years, you should review your advance directives and make changes accordingly. This is true for all your estate plan documents. Two key events particularly underscore the need for an update:
- A new diagnosis, a terminal illness, or disease that will alter your way of life; and
- Marriage or divorce, i.e. you may want to change who you appoint as your health care proxy or agent.
The Benefits of Having an Advance Directive as Part of an Estate Plan in Washington
Drafting a healthcare directive is a task many people would rather avoid, as it forces us to confront the possibility of serious medical concerns. Yet, even those who are young and in good health can find immense value in having one prepared. Much like an insurance policy, a healthcare directive provides essential support in times of need, whether those needs are expected or arise suddenly. Moreover, it greatly minimizes confusion during critical moments when quick decisions are required, easing the uncertainty and emotional burden others might feel when faced with making life-altering choices on your behalf.
Do Not Attempt Resuscitation
DNR/DNAR (Do Not Resuscitate/Do Not Attempt Resuscitation) orders instruct health care teams to withhold resuscitative measures based on the patient's wishes. These orders are applicable to any patient at risk of cardiopulmonary arrest, regardless of age or terminal illness status, and are valid in all care settings. If a cardiopulmonary arrest occurs without a DNAR order, resuscitation will be attempted if medically appropriate, but will be halted if it's later found that the patient was in possession of a DNAR.
What is Resuscitation?
Resuscitation is treatment given when a person's blood flow or breathing stops. Medical professionals have several ways of resuscitating patients, including but not limited to:
- Cardiopulmonary resuscitation (CPR), which involves mouth-to-mouth breathing and pressing on the chest
- Advanced cardiac life support (ACLS)
- Defibrillation
- Assisted breathing machines, like a ventilator
- Medicines
Resuscitation methods may spare a patient from death, yet leave them in a compromised or diminished state. Those who want to avoid a reduction in the quality of life from resuscitation can create and sign a Do-Not-Attempt-Resuscitation order. This would prevent medical professionals from attempting resuscitating under any circumstances.
How DNRs Work in Washington
A DNR is a legally-binding, dated order, written and signed by your physician with the patient's name. A doctor may issue a DNR order only after consulting with you (the patient), your designated representative, or a family member. Once in place, this order directs medical providers to withhold resuscitation efforts for the named patient. The specifics of DNR orders can vary by state; some are time-limited and expire after a certain period, while others remain in effect indefinitely.
Like a living will, DNRs allow you to express your preferences regarding life preserving care. Unlike these other forms of healthcare directives, though, DNRs are very straightforward: they tell doctors not to resuscitate the patient. CPR and other forms of resuscitation are automatically performed to save a person's life in the absence of an appropriate DNR order.
A DNR order can exist as an independent document or as a component of a broader advance directive. An advance directive encompasses all legal instructions related to a patient's medical care, including health care proxies and living wills.
Can Anything Override a DNR Order in Washington?
Once a doctor writes a DNR order upon your request, no one can override it without power of attorney––including family members. You also maintain the ability to revoke the DNR at any time, as long as you have the capacity to make medical decisions. It is important to note that a power of attorney could revoke the DNR if they believe it best while you are incapacitated. Due to this, it is important to consider a healthcare directive, which will have ultimate authority of your medical care in the event of incapacitation.
Things to Consider Prior to Signing a DNR in Spokane
When considering signing a DNR. Here's a short list.
- Do you have any religious, ethical, or moral beliefs opposed to resuscitation? Some religions oppose resuscitation methods while some people are simply opposed to the idea on moral or ethical grounds.
- Why do you not want to be resuscitated? Are you ill or have you been diagnosed with a terminal illness? Sometimes a person who is not terminally ill may want a DNR order if their health and quality of life is generally deteriorating.
- Do the side effects worry you? Even if resuscitation is successful, the side effects can be severe. Chest compressions, for example, may result in broken ribs, punctured lungs, or heart damage. For an older individual, these injuries can be especially profound.
- Do survival rates concern you? For individuals over the age of 70, survival rates following resuscitation are often low. While statistics vary, many elderly patients face disheartening outcomes, leading some to feel that resuscitation merely delays the inevitable. However, it's crucial to remember that each person's situation is unique, and a positive prognosis is still possible, even when the statistics suggest otherwise.
Physicians should discuss resuscitation early with the patient while they have decision-making capacity, including the patient's surrogate decision-maker in the conversation. Before entering a DNAR order, physicians must explain the procedures and outcomes, confirm the patient's wishes, and tailor the order to reflect their preferences. The order should be revisited and revised as the patient's condition changes, and documented thoroughly in the medical record.
If a patient lacks decision-making capacity and has no prior directive, the physician must consult with the patient's surrogate or, if absent, with an ethics committee before making DNAR decisions. In cases of disagreement, ethical consultations should be sought to help determine the most appropriate steps forward.
Contact an Estate Planning Lawyer in Washington Today
At The Whipple Law Group, we want to make sure you do what is best for you. Having a comprehensive, thorough estate plan is your best insurance to make sure your preferences regarding your medical treatment and the management of your estate are carried out the way you want them to be. Contact us online or at 509-869-3223 to schedule a consultation.
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