Is a living will pretty much the same thing as a DNR or do I need both?

[NNN0LHI]

Recently I had my living will drawn up and the lawyer said I had three choices from mild to drastic steps to end my life if I somehow end up out of it.

I took the most drastic choice as I have no intention of laying in an ICU unit with a breathing tube down my throat for any length of time if it doesn't appear that I would recover from a heart attack, stroke or whatever.

But is that the same as a DNR or should I get one of them too? Anyone know the difference? Is there any difference?

Almost forgot. Who would you give your living will and/or DNR to? Because the person holding that piece of paper is who has to make the final decision as to when and if my wishes are carried out. Would I want to make my wife or kids make the final decision to present the DNR to the hospital and put them through that? Or would a good friend (like a best friend) be better to be the one responsible for handling something like this?

Sorry about a lot of questions on a not very happy subject but I want to be prepared when the time comes. And I ain't getting any younger.

Don

[leftofcool]

1. You need a living will

We have a regular will, a living will and a DNR. Typically, it is a family member who makes the final decision although, you can have your living will set up so that someone else makes that decision depending on the laws of your state. If your wife is not in a position to make the decision, (ie ill, incapicated etc...) you will need someone alternate to do so anyway. Be sure you living will is registered and you have a copy on file with your doctor and with the hospital.

[livetohike]

2. We just had ours done at the attorney's office last week

Since you went to an attorney, I think he/she must have given you the correct paperwork for your state, as long as your wishes are spelled out. That should do it :hi:.

Oh, and I gave my sister a copy, too. So if my husband survives me, she will also know what my wishes were and the two of them can make the right decisions.

[leftofcool]

4. Good idea on the sister

We choose our sons to make the decision if one of us was gone or couldn't but I think we may revise that just in case our sons are also gone. Can't hurt to have a third person in there.

[livetohike]

9. It's such a stressful decision (from experience)

It's good to get it in writing and discuss it with your family, too. Luckily my sister and I are close (neither of us have kids).

[HockeyMom]

7. My Mom gave me Power of Attorney also

I hear that nowadays it usually goes along with the Living Will, naming someone to represent you if you become incapable of making decisions.

My memory is a bit fuzzy after 20+ years, but I do remember signing a lot of papers when she was admitted to the hospital, even though she was fully rational when she was admitted.

Speak with an attorney regarding this. It cannot hurt.

[sharesunited]

3. A DNR is not something you write for yourself.

You make your wishes known in a living will or to the person you have appointed under a health care power of attorney. A physician issues the DNR.

[Tangerine LaBamba]

12. Exactly

Everyone needs a Health Care Power Of Attorney. I helped write the definitive template for that document years ago at the behest of AARP. They might still have it somewhere in their files. I know that they sent out a zillion of them.

[Warpy]

5. Not really. For instance, that living will will not cover you

during surgery when heroics will be performed should something go wrong.

Your best bet is to have a durable power of attorney for medical decisions drawn up so that some family member you barely know can't fly in and threaten lawsuits if they don't do everything. Some docs will be more afraid of the family member than they are of your ability to sue for assault should you recover.

In any case, the hospital needs to have your living will copied and the copy placed in your permanent chart the next time you go in for anything. That will relieve your family of the necessity of bringing it in should you become incapable of making your own decisions.

As for the power of attorney, a first degree relative like a spouse or child is preferable to a friend.

[Yael]

13. The Durable POA is what I completed

Just after the Terri Schiavo fiasco. Legalzoom.com was doing them for free -- one day only.

[librechik]

6. a copy of the DNR/living will should be in your medical chart at your doctor's office.

otherwise, with you important papers at home for your family to have access to. Your loved ones deserve to care for you in that final way as they have cared for you all through life--don't put it off on a friend. (it won't be aany easier on him and could cause problems down the road.

Anyway, this is YOUR decision and the drs and nurses caring for you. Nobody wants you to suffer unnecessarily, but they need your written word on that.

[Yael]

14. I would have never thought of that.

Thanks!

[zanne]

15. Whenever the ambulance transported my mother to the ER...

I was required to have the original DNR order on my person so I could give it to the attendents in case she flatlined on the way there.

[LeftCoast]

8. If I understand your question correctly...

a DNR is simply an instruction to doctors, nurses and other medical staff to not engage in extraordinary measures to prolong your life in case of a life-threatening emergency. You may also order gradations of support, such as chemical resuscitation only, or no-chest compressions, etc.

A living will aka an Advanced Health Care Directive is more broad. It tells everyone concerned what your wishes are in terms of medical care in case you become incapacitated and longer able to speak for yourself. This usually includes instructions such as "I wish to be a DNR". It also covers things like if you wish to be kept alive with a tube feed, or whether you want to allow doctors to intubate you. It really helps to discuss all of these things with a family doctor and probably wouldn't hurt to also run it by a lawyer, particularly if significant financial assets are at stake.

Hope this helps.

[Lars39]

10. DNR is a component of a living will.

You need to make sure there are copies at home for each ambulance trip, a copy in your chart at *every* doctor's office you use. If you have an attorney-in-fact for medical issues, the POA will have to be turned in for each hospital stay, too.
You need to discuss your living will and what you want done with all your doctors, stressing that whoever you have chosen as having POA for medical decisions has the final say if you are incapacitated.

A good living will will stress that you(the patient) should be consulted for decisions, because you could possibly change your mind once faced with certain possibilities.

Hard learned lessons from this past year. :(

[Yael]

11. Each state is different. Your lawyer will know.

I gave copies to my Mother and Sister.

[qijackie]

16. You need quite a bit of stuff

I have quite a lot of experience with this issue and would like to share it but it will take me awhile to organize my thoughts to be as concise as possible. I can tell you that lawyers often do NOT know or do not tell you so you must research this issue yourself. Plus the canned documents are not adequate. If you want me to go on, let me know and I will post the info from my perspective a bit later.

[NNN0LHI]

17. I would very much like to hear any other of your perspective on this

Whenever you have the time of course.

Thank you and everyone who helped on this subject.

It appears by the responses here that my wife and I aren't alone in trying to get this stuff straight.

Don

[Frances]

18. My husband and I have durable power of attorney for health

documents. I gave a copy of them to our primary care physician who said he'd have them scanned into our computerized medical records. Now I'm thinking I should also give a copy to my husband's cardiologist so that he can scan a copy into his medical records as well.

[qijackie]

19. OK - here's a long post!!

From my personal experience - being a 24/7 caretaker for my mother who has had many emergencies - I am her Power of Attorney for health and for financial decisions, I am her trustee on her house, I am the one who makes sure all legal documents are current and so on -

Much depends on how old you are and your state of health (sorry to be obvious) and you MUST review the documents every year or so. Also, keep in mind that a family member can create a horrible mess if they decide you are going to be saved after all and if they take a stand and threaten to sue and so on..... regardless of any papers, done with a lawyer or not. But it is true that your odds are better if your documents are properly drawn up AND if your closest relatives agree with your decision. Once you plow through all this stuff the first time, reviews & changes really aren't that bad.

First, you need a Durable Power of Attorney for Healthcare Decisions - whatever the title is in your state. You need to choose a person that you trust to best carry out your wishes to be your representative on this document. You need one or two back-ups in case the named first rep cannot or will not serve when the time comes. Copies should be given to all doctors you are involved with and all hospitals you are involved with. However, they tend to lose them or ignore them so you should have several copies in an envelope that always travels with you when/if you go to ER or if you are admitted to a hospital. Then your rep can hand them out to anyone who needs them. Believe me, you will need lots of copies.

You also need to review the provisions in this document and think "outside the boilerplate" so to speak. It rarely covers things like do you want your limbs amputated if you are 90 years old? This came up for me this year due to surgery on my mom's leg for circulation. Well, as it turns out, often old people don't have whatever it takes to get through leg bypass surgery successfully and so legs get lopped off fairly routinely. Her surgeon said that most people choose amputation when push comes to shove. OK - maybe they do. But my mom didn't - so I had to make this very clear to her surgeon - no cutting. To say nothing of the fact that she has dementia so without legs she would just be a lump til she died. So also think about your possible mental state....if you have dementia, do you really want to lay around without your cognitive faculties and without your limbs? So think about things like that and add some of your own provisions to the document.

You also need a DNR - this is a Do Not Resuscitate order - this is for two primary areas.... the EMT team if 911 or something similar is involved. If you are old and frail, you definitely want one and you want it in the container (see the Vial of Life) on your fridge. You also want it with your medications and anywhere else the EMT team might look for info on you. This means if you are having an attack of some sort, they are NOT to do CPR on you or do anything else that will "bring you back" if you have stopped breathing for any reason. Especially if you are old, you need to think about this carefully because usually when an EMT team does CPR or heart massage on an old person, they break the ribs. Then the old person gets to be in agony and die later. But the EMT teams have no choice....they MUST try to save your butt if they can UNLESS a DNR is there in their faces. In the hospital, if a crisis occurs (the old code blue thing) and you don't want them to save you, you'd best make sure there is a DNR filed AND someone has to make sure the surgeons and OR team know about it. Or they will do what they do best which is save you so you don't die on the table (surgeons hate that) but die later in a more horrible way.

The format of a DNR is often different in different states because some want a physician to sign and some a notary and some only a signature. However, having anything with your signature is better than having nothing!! It isn't a doctor's decision - it is yours - unless you are not able to indicate your wishes and you don't have a DNR, then it is up to whoever is there at the time. The first thing you do with a DNR is make a ton of copies once again. I read about a woman who had Do Not Resuscitate tattooed on her chest but it was ruled invalid - so don't assume anything!!! Again put the original away and put a bunch of copies in "the" envelope and your rep will have it there when needed.

Additionally, if you want to be really ahead, you will write a letter explaining your current feelings on things and keep it with your stuff for your rep.

You also need to be informed regarding Medicare - I assume you will be getting Soc Sec at some age and that you will be signing up for Medicare at age 65 (regardless of when you take Soc Sec). What they do and do not pay for is insidious - learn the basic rules and you will be ahead. Of course you know this for your usual medical insurance, but you need to learn the Medicare world as well, preferably before you need it.

That's about all you can do for your medical world interactions. But your most important thing to have is someone in your corner who will take the time and trouble to talk to the doctors and fight for good (and appropriate) care for you. Basically, care is pretty bad now in the US and it won't get better. Not enough nurses or CNAs, not enough beds in the hospitals or nursing facilities. And so on.

The other thing you need to think carefully about (besides your will and general estate planning...oh, what a pain) is arranging for someone to have your Financial Power of Attorney - at a minimum it should go into effect if you are incapicated...that is, unable to carry out financial transactions yourself. It can be limited, it can be unlimited, it can be for a short time, it can be for a long time....whatever. Usually the lawyer's boilerplate for this is not good enough although we all think it is....but it isn't. Plus, some financial institutions only accept their own signed paperwork...ask your bank or whatever other financial institutions with which you do business. It really is endless!!! But you don't have to tackle all the issues at once - pick one, like the medical thing, do it and then move on to the next thing. I think I have an extremely comprehensive Financial Power of Attorney for my mom with many provisions I had my lawyer add to their standard document. But I have no doubt someone somewhere could cause trouble if they wanted to do so.

Finally, re lawyers.... you can actually do all this stuff yourself and make sure all documents are properly notarized. But it really is a pain. Or you can pay a lawyer to write the stuff up once you know what you want it to say. But I advise you to go to a lawyer who is genuinely well versed in Elder Law (the new thing). Better for them to know all about the whole thing, including medicaid in your state. If you are really really wealthy, I doubt you would be asking for this info on DU - so I assume you want to get the biggest bang for your bucks with a lawyer. And I found that most haven't a clue about the ins and outs of all the stuff we need to know and prepare for when aging in this country.

For myself, I want everything I can get that will try to ensure that no one saves me!!! I do not want the life my mom has even though she has excellent care. But I also realize it is easy to say when I'm doing ok - maybe when I am having a heart attack or whatever, I would want to live. Or, more frightening, I won't have enough marbles to decide.

Hey, I'm sorry if this went on and on and on but the topic is actually pretty complicated. As you know if you followed the absurd stuff that happened around the Schivo case. And this is just what I've learned dealing with my mom here in California. Remember.... There's a Million Stories in the Naked City (!!) and this is just one!