February 2009
What You Need to Know About Living Wills and DNR (Do-Not-Resuscitate) Orders
 
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A living will is a document which is meant to tell healthcare providers what kind of medical care you do or do not want to receive if you are unable to express your wishes. A DNR order is a medical order written by your doctor indicating you do not wish to undergo cardiopulmonary resuscitation or “CPR” if your heart stops beating or you stop breathing. Living wills and DNR orders are meant to let healthcare providers know your values and wishes about medical care. However, in a four-year-period, over 200 reports were submitted to the Pennsylvania Patient Safety Authority that show in part that healthcare providers, as well as patients and families, may not understand the meanings of living wills and DNR orders. The data shows there are potential patient safety risks related to misinterpretation of living wills and DNR orders that include patients potentially receiving unwanted care and potentially not receiving care according to their wishes in a living will.

What You Need to Know About Pennsylvania Law and Living Wills:

Under Pennsylvania law, you may state your wishes about medical care through written instructions in an “advance healthcare directive” in the event that you become unable to make your own decisions. An “advance healthcare directive” can include a number of different documents intended to let your healthcare providers know your preferences about the medical care you wish to receive if you can no longer make your wishes known. Some advance healthcare directives are intended to appoint a person to make decisions on your behalf when you are unable to do so; some authorize another person to admit you to a nursing or other type of healthcare facility under certain circumstances; and some give specific instructions about what kind of medical care and under what circumstances that medical care is to be provided or withheld.

A living will is a type of advance healthcare directive you can use to indicate your wishes about medical care in the event that you become unable to make your own decisions. In Pennsylvania, a living will comes into effect only if you are incompetent and you have an end-stage medical condition or you are permanently unconscious. The law allows your doctor to decide if you are incompetent, which means you can no longer make decisions for yourself. You can change your mind about your living will at any time.

What You Need to Know About Living Wills and DNR Orders

DNR (Do-Not-Resuscitate) Order - A DNR order is a medical order that directs healthcare providers not to administer CPR if you have a heart attack or stop breathing. A DNR order only comes into effect if you suffer a heart attack or stop breathing. A DNR order does not mean other medical treatments or life-sustaining interventions will not be done. Know that with every hospital or nursing home visit you must restate your wishes in regard to any DNR order. DNR orders do not carry over from visit to visit.

You may have a living will or a DNR order or both. It is important to understand when each of them may become effective. If you have a living will you should know that even if your living will indicates that you do not want CPR, you may still receive CPR if you experience a heart attack or stop breathing if your living will has not come into effect or your doctor has not entered a DNR order into your medical record.

Miscommunication Issues Regarding DNR Orders

Another issue regarding DNR orders reported to the Authority is the potential for a breakdown in communication between healthcare providers and between healthcare providers, patients and families. Seventy-one reports submitted through PA-PSRS from June 2004 to September 2008 show some form of communication breakdown related to living wills and DNR orders. Of the issues reported, the majority of reports involve the lack of understanding of the meaning of the documents by families, lack of communication of the presence of a DNR order between healthcare providers, misidentification of patients and the failure to identify patients with DNR orders.

Key Points
  • It is important for you understand what you are requesting when writing a living will or requesting a DNR order. Don’t hesitate to discuss the matter at length with your healthcare provider to ensure you both understand what your wishes are in regard to a living will or a DNR order. Living wills are directed by law, however DNR orders vary from facility to facility as to what care is given.

  • It is important for you to tell your family and healthcare providers about your wishes regarding life-saving medical treatment that you wish to have should you become unable to make decisions for yourself. A lawyer may or may not be present when you write your living will.

  • DNR order requests need to be communicated every time you  stay in a hospital or nursing home. The DNR order does not carry over from visit to visit.

  • In Pennsylvania, a living will comes into effect only if you are incompetent and you have an end-stage medical condition or you are permanently unconscious.

  • A DNR order is a medical order that directs healthcare providers not to administer CPR in the event of a heart attack or you stop breathing. However, DNR does not mean “do not treat.”

For more information on living wills and DNR orders talk to your healthcare provider. For real-life cases and more information about the Pennsylvania Patient Safety Advisory article “Understanding Living Will and DNR Orders” go to the December 2008 Patient Safety Advisory by clicking here.

©2018 Pennsylvania Patient Safety Authority