Advance Directives for People Who Are Seriously Ill
Do Not Resuscitate (DNR) Orders
A Do Not Resuscitate (DNR) order is a medical form signed by a doctor. It tells medical personnel not to begin cardiopulmonary resuscitation (CPR), even if a person’s heart and breathing have stopped. DNR orders are generally appropriate for people who are terminally ill or have a serious medical illness.
If you think a DNR order may be right for you, talk with your doctor. They will discuss your goals of care and make sure that you understand that you will not be resuscitated if you have a DNR. Once they’re sure that you understand what a DNR entails, they will sign the form and update your medical record. In some places, DNR orders may only be valid in a healthcare facility. In this case, you may need another document, like an out-of-hospital DNR Order or a Portable Medical Order (see below for more information).
Be sure to discuss your DNR order with your caregivers, loved ones, and healthcare decision makers. To be effective in an emergency, the DNR order must be easily accessible so that emergency personnel can follow its instructions. If you enter a healthcare facility, make sure to alert them about your DNR order and give them a copy. Some people also choose to have a wearable indicator (like a DNR bracelet) to tell medical personnel about their DNR order, just in case they become incapacitated and can’t speak.
Portable Medical Orders (POLST, MOLST, COLST)
Portable Medical Orders are official medical forms that you keep with you outside of healthcare facilities. If you have a medical emergency and are unable to communicate, a Portable Medical Order tells emergency personnel what treatments you want and what your goals of care are.
When a healthy person experiences an unanticipated medical emergency, emergency personnel are instructed to provide all reasonable care to save that person’s life. But this may not be appropriate for someone with a serious illness, with advanced frailty, or who is nearing the end of their life. For instance, someone with a terminal illness may decide that they do not want a tube placed down their throat if they’re having trouble breathing. Or they may decide that they do want mechanical assistance with breathing, but only for a trial period to see if it can bring them back to a state where they can breath on their own. These types of choices, among others, can be indicated in a POLST form.
If you believe POLST may be right for you, start the process by having a conversation with your healthcare provider. Your doctor will discuss your treatment options and goals of care with you first before they sign your POLST form.
Once your doctor has signed your POLST form, it’s important to keep the form in an easily accessible location. Let your loved ones know where it is so that they can tell emergency personnel where to find it. Common locations are near front doors or on fridges. POLST forms are often printed on brightly colored paper to make them more visible.
If you would like more information, National POLST is a great program that provides helpful guidance about the Portable Medical Order process.
The Completed Life Initiative does not provide direct patient healthcare, nor does it provide legal services. We help individuals navigate their end-of-life choices with dignity and autonomy, in consultation with their clinicians and care team.