I begin with the now “old”, March 2013 instance of an 87-year-old denied CPR from a long-term care facility staff member while on the phone with EMS via a 911 call. (You can search Glenwood Gardens, 87 year old, CPR)
This is neither medical nor legal advice, nor a judgment regarding the single family or any of its members involved. The issues presented by the occurrence are important for consideration purposes only.
In its support of the facility, Forbes.com on 3/6/2013 admitted that “It is not clear whether she had a living will or do not resuscitate order, or had a designated a family member as her healthcare proxy.”
In terror, we should all be considering that regardless of our prior documentation, a contract with a long-term care facility can dominate and govern the treatment available to each of us in a moment of emergency. All that we know is that in this section of this facility the most promised was to call 911, which was done.
First and foremost, read ANY CONTRACT you sign. What is provided for (a call to 911) is as important as what is NOT provided for (follow 911 EMS personnel’s advice once you call). It can fairly be assumed that this woman never considered that the staff calling 911 would disregard instructions provided by EMS personnel.
Second, your intentions, as indicated in a living will, which frequently outlines the medical care you want or don’t want, depending on where you live, will either not be relevant until you’re hospitalized, or will take a back seat to other indicators of your desires in the event of an emergency (such as the signed contract with the facility).
You should also note that if you have an older living will, it likely omits recent medical developments that you might want to include or exclude among your choices. If you’ve got an older document, especially, you’re limited. I really prefer the idea of having a trusted person who is determined to carry out YOUR wishes as your healthcare proxy (or medical proxy, or as holder of your healthcare power of attorney, whatever name is used in your region).
Third. Make sure your healthcare agent understands you and your intentions. In the above case, whether the woman had a healthcare agent was deemed irrelevant, since that person's authority only comes into play when someone is unable to make medical decisions for him or herself. Interestingly, while there was no apparent effort to determine whether such an agent-appointment document existed,and while the assumption is usually that a person wants CPR, the CONTRACT prevailed until EMS was on-site at which point CPR was administered. It's also a little strange, but the family seems to indicate that even if they'd been asked they would have denied CPR (as per references to claims by daughter that mom didn't want CPR in a medical emergency).
Fourth. Make sure you believe that your healthcare agent will follow your wishes as communicated to him or her. Make sure that agents are good LISTENERS, hearing your desires and willing to carry them out because you are giving them power to act as you in terms of making medical decisions for you. Try, where possible to AVOID assigning a healthcare proxy to someone who has a financial interest in your estate if you think, for a moment that a love of money could cloud his or her judgment.
Fifth. Remember that a healthcare agent (or proxy, et cetera) usually PREVAILS OVER AN APPOINTED GUARDIAN in matters of making healthcare decisions. You can use a durable power of attorney to appoint a guardian, in the event you need one, for a variety of matters. If at some point, you decide to have the same person as your guardian and healthcare agent, MAKE SURE YOU SPECIFICALLY REVOKE OTHER DOCUMENTS. If you have a living will you expect your healthcare agent to follow, make sure that he or she, in addition to your physician and others has a copy of the living will.
Sixth. The DNR Directive only applies to CPR. If you sign a DNR it will likely CONTINUE until it is revoked by you, your agent, or in some instances your physician. If you go home and then return to a hospital where you have a signed DNR, it is likely STILL valid. Make certain that your healthcare agent understands your intentions regarding CPR.
In the above instance with the older woman, there was no known DNR, though her daughter expressed that her mother’s wishes for non-resuscitation. Here’s the problem. While it’s usually presumed that ABSENT a DNR, a person would desire CPR, here, again, the CONTRACT prevailed.
In Summary:
If you choose to go into a long-term care facility, bring the contract to an attorney to explain to you. It will be the best couple of hundred dollars you can spend in the process.
If you decide to appoint a healthcare agent via healthcare proxy or healthcare power of attorney, make sure that such person understands and is willing to carry out YOUR wishes. Make sure that others know that such person is your healthcare agent. Consider separating possible financial incentives from the power a healthcare agent holds.
Consider the pros and especially, the cons of every document you publish in terms of healthcare directives. It is difficult to make sure they reach the right hands at the right time, and they must be specifically revoked in a way that interested parties are all aware of your revocation, in order not to have implications through time.
Tell your healthcare agent, physician, and everyone else that you want CPR,if this is the case. While the presumption is usually made that a person would want CPR, things happen.
