The importance of having an estate plan and advance health care directives cannot be overstated. These documents can provide a clear expression of your wishes regarding property, finances, and medical decisions in the event you become incapacitated or die. Outlining these preferences in advance can ensure that your wishes are respected and that your loved ones don’t have to make these difficult decisions on your behalf.
A do-not-resuscitate order, commonly referred to as a “DNR,” is a legally binding directive to all of a patient’s health care providers. Although considered one of several advance health care directives, this document is typically not part of one’s estate plan.
As noted by its title, it instructs caregivers to abstain from providing life support measures to a patient in the event that the patient stops breathing or his heart stops beating. Specifically, it orders caregivers not to provide conventional CPR, defibrillation, heart massage, or any other techniques that may be deemed invasive in order to revive the patient. In New Jersey, absent a DNR, Emergency Medical Service (EMS) personnel will engage in full resuscitative efforts when a patient is in cardiac or respiratory arrest.
There are a number of reasons why one may want to put a DNR order in place, such as maintaining a certain quality of life, not wanting to prolong a terminal illness, or religious or ethical beliefs. This decision is deeply personal and should be made in consultation with healthcare providers, family members and loved ones, or other trusted individuals, such as therapists.
DNR at the Hospital or at Home
A DNR can be initiated with your consent by your primary or attending physician when you are admitted to a hospital, nursing home, or hospice facility, if he/she feels you are suffering from a terminal illness and recovery is unlikely. The DNR is then included in your chart so that the facility’s staff will be aware of your wish not to be resuscitated should your heart or lungs cease functioning.
In New Jersey, an out-of-hospital DNR can also be initiated for a patient receiving end of life care at home. The patient is usually provided with a bracelet so that Emergency Medical Service (EMS) first responders are aware of the person’s wishes not to be resuscitated.
A do-not-resuscitate order is a serious legal document and if knowingly ignored by a medical provider, there are both professional and legal consequences for violating a patient’s rights.
Requirements for Establishing a DNR Order
In general, to establish a DNR, the individual must be considered mentally competent and fully informed. But, what if someone is not considered mentally competent? In this situation a surrogate can set up the do-not-resuscitate order. Ideally, such a surrogate or health care agent is designated by a health care proxy, usually called a medical power of attorney. The surrogate can be a family member, attorney, court appointed guardian, or any individual deemed responsible to make health care decisions on a patient’s behalf.
If you have not appointed someone to speak for you, a family member could agree to set up a DNR order on your behalf. However, this could create problems if your family members do not agree with that decision.
Other considerations when determining the appropriateness of a DNR order include whether life-sustaining treatment is likely to be ineffective or futile, whether the patient is permanently unconscious, whether the patient is in a terminal condition, and whether the burdens of resuscitation outweigh the benefits.
Having a Plan in Place
As you can see, a DNR is an important document to have in certain circumstances. You can establish it upon admission to a hospital, or similar facility, or while receiving end of life care at home. Regardless of whether you need a DNR or not, the most important point is to have a plan in place before an emergency strikes. At a minimum, you need the appropriate advance health care directives (i.e., living will, health care power of attorney with a HIPPA release) in place.
If you have any questions on the DNR, advance health care directives, or anything else related to estate planning, please do not hesitate to contact our New Jersey estate planning attorneys at AJC Law at (201) 273-9763 or through our website.