A good piece on some of the limitations of advance directives and Do Not Resuscitate (DNRs) instructions i real-life scenarios, and some of the confusion that results. There is also the development of Physician Orders for Life-Sustaining Treatment (POLST), which travels with the patient’s medical records (and is brightly coloured, in this still paper-based age, to stand out). The following checklist is to reduce some of the interpretation issues. Quote:
When physicians encounter a situation where a patient has an advance directive, going through a short checklist may help to ensure that a patient’s wishes are followed correctly. The list, developed by Ferdinando Mirarchi, DO, and called the “resuscitation pause,” starts with the first five letters of the alphabet for easier recollection.
A: Ask patients or surrogates about the intention of their living will or DNR order.
B: Be clear about whether the patient’s condition is terminal, despite sound medical treatment, or whether the patient is experiencing a critical condition that is treatable.
C: Communicate clearly with patients and staff members if you feel the patient’s condition is reversible and/or treatable.
D: Discuss next steps with patients or surrogates and talk about an action plan. For example, if a patient is critically ill, medical staff and family members may agree to institute care for 72 hours. If no benefit is found, life-sustaining care can be withdrawn.
E: Explain to family members and staff that it’s OK to withhold or withdraw certain care as long as it correlates with the patient’s preconceived wishes.