What is a DNR in Hospice? The Meaning of Advance Directives.


Simplified information about Advance Directives,  and what they really  mean for someone who is receiving Hospice Services.

There are several different types of advance directives, and Department Health and Human Services is an excellent resource for creating a Living Will , or establishing a Durable Power of Attorney.  While these are valuable advance directives, in hospice there are two other directives that are also very important.

It is my hope to provide some clarity on what it means to designate someone as a Medical Power of Attorney, and the value of a Do Not Resuscitate Order.

This is a difficult conversation to have with your loved ones concerning the end of life, but an important one.  Right now, you may have some control over what it happening, and a voice in the medical decisions that are being made on your behalf.  At some point, that ability may be impaired, and then someone else may have to step in and make those difficult decisions for you.  An advance directive is an opportunity for you to have a voice, and some control over what will happen.  These directives will also relieve some of the pressure off of your loved ones, because they will clearly know how to honor your wishes.

Designating someone as your Medical Power of Attorney is very easy to do, and it is always highly recommended.

Your Medical Power of Attorney is the person that you appoint to make decisions on your behalf regarding your medical care, only if you were unable to make them for yourself.  There is a simple form that can filled out, and it only requires a couple of signatures from witnesses that are not related to you.  That is it! You are done!

A very important point to make about this advance directive…Your designated Medical Power of Attorney is not able make decisions regarding your medical care, if you are capable of making those decisions for yourself.   If you decide not to elect a Medical Power of Attorney, and someone needs to advocate for you, then the decision making power would be deferred to whoever is your closest next of kin. Usually the order for “next of kin” is as follows: spouse, parents, children, siblings, and extended family in that order.

There are some general misconceptions surrounding an Out Of Hospital Do Not Resuscitate Order (DNR), and it is a tough conversation.

This is an important advance directive often referred as a DNR, and it means that if you were to pass away from natural causes,  that you have chosen to not seek aggressive measures like CPR.  Sometimes this subject can be uncomfortable, but I would encourage you to have an open discussion on the topic with your loved ones, and your doctor. One the other hand, a DNR can also provide some peace of mind for you and your loved ones, especially when they clearly know how to honor your wishes.

One important detail about a DNR that I would like to point out ..

A DNR is NOT a binding agreement, and CAN BE REVOKED by you or your loved one at any time.

This short video clip offers an informative explanation of a DNR.

Does Hospice require a DNR?

The answer is NO, and there are many hospice patients that have elected to NOT have a DNR.  It is my belief that much of this is driven by fear and misunderstanding.  The only thing that we can do as hospice providers,  is try to present advance directives as clearly as possible, so patients can make the best informed decision for themselves.

Generally if someone on hospice passes away and does not have a DNR order, hospice will respond and simultaneously place a call to 911 to alert local EMS.  Often times the police and fire department will also respond to the call accordingly.   From that point, the appropriate actions are taken, and are truly dependent on their unique circumstances.  One of the basic principles of hospice care is that everyone has the right to die free from pain and with dignity.  This scenario of creating an emergent situation at the end of life, does not foster the idea of dying peacefully in a dignified manner.

It takes courage to make these kinds of decisions.  This is one way that you can give something back to your loved ones.

 

Completing a DNR is pretty straight forward, and there is a standard form that is used.  Similar to the Medical Power of Attorney, it requires two witness signatures from people that are not related to you.  The primary difference is… a DNR requires Validation from a doctor,  usually your Hospice Medical Director.  Once you have  the official copy, it is kept at the bedside. One other important thing to note… you must have information on the front and the back of the form, in order for it to be truly valid.

I hope that you found this information useful, please feel free to ask questions or leave a comment.




10 Comments

  • Thabo April 20, 2017 at 3:32 am

    Hi Heather,

    My mom is sickly and a couple years ago things got really scary but thank God she made it through the episode okay. Afterward, she wanted to have a discussion about her “final Plans”. I remember her saying over and over again, “I don’t want to be kept alive by artificial means.” It was a very difficult discussion and we both let it drop, never pursuing the matter any further.

    Your website, however, made me reconsider a few things and I think next time I’ll let mom finish what she wanted to tell me.

    Reply
    • Heather Williams RN CHPN April 20, 2017 at 3:48 am

      Thank you so much for taking the time to read my post and for sharing your personal experience. It sounds like you really love your mom, and you are going to be an excellent advocate for her one day if the need arises. Many Blessing to You and Your Loved Ones. Heather

      Reply
  • Ryan Crane April 20, 2017 at 4:18 am

    Great article! My loved one is in hospice now, and I’m very clueless when it comes to stuff like this. Very informative!

    Reply
    • Heather Williams RN CHPN April 20, 2017 at 4:23 am

      Hi Ryan,
      Thanks for taking the time to look around, and I am very sorry for what you and your loved ones are going through. Let me know if I can be of any assistance. Many Blessings.
      Take Care,
      Heather

      Reply
  • Patricia April 20, 2017 at 10:56 am

    Thank you for your article. As we age and our parents and loved ones age along with us, we are forced to learn about advanced medical directives and DNR orders. They are scary ideas but your article helps us face our fears and learn what they do and do not mean. Thank you for posting this!

    Reply
    • Heather Williams RN CHPN April 20, 2017 at 9:27 pm

      Thank you for taking time, and I am glad that you found the information useful.
      Take Care,
      Heather

      Reply
  • Maggie April 20, 2017 at 11:27 am

    Hello. Glad I found your site. It’s full of helpful information. There’s so much confusion around this topic and it’s very difficult for families to make decisions at this stressful time. Thanks for breaking the terminology down so clearly. Your recommended reading section is helpful also. I’ve read ‘When breath becomes air’ and the way he faces his own mortality is inspiring. Thanks for sharing.

    Reply
    • Heather Williams RN CHPN April 20, 2017 at 9:25 pm

      Thank you Maggie. There are many books about hospice, but “When Breath Becomes Air”is an exceptional book. Dr. Kalanithi was a bright light in this world, and died too young. Cancer is very difficult disease process to wrap your mind around really.
      Many Blessings,
      Heather

      Reply
  • jeffrey16201 April 20, 2017 at 2:50 pm

    Very interesting article and one many people must consider at one time in their lives, I have great respect for hospice they people who work for them and volunteer are very dedicated to their patients and do everything they possibly can to help them.

    How does one become a volunteer for hospice, do you need some type of health experience to be a volunteer

    Reply
    • Heather Williams RN CHPN April 20, 2017 at 9:11 pm

      Thank you for your interest. Volunteers are vital part of the hospice organization, and they sit with the patients to provide emotional support, but they are not able to provide any hands on care. Volunteers do not have to have an prior healthcare experience, just a warm heart. All Hopsice agencies are required to have a volunteer program, and those individuals that volunteer go through an orientation process and are required to sign some confidentiality paperwork, because of the need to protect patient’s privacy. Hope that helps. Take Care, Heather

      Reply

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