A few of us braved the rain Sunday night to attend the support group meeting. I thought I would pass on one of the short discussions some of us had, and give you some related links to forms and info available online.
Cheri said that several people told her she could get a DNR (do not resuscitate) form from her doctor. Well, she asked two doctors and neither had such a form. She said that she had been advised to get such a form for her husband and sign it because if you don’t have such a form emergency medical personnel can go down a path the patient and family don’t want to go down. However, Cheri pointed out that even if you have a signed DNR, the healthcare POA (power of attorney) can always say “we want resuscitation efforts to be made.” Having a signed DNR gives the healthcare POA some flexibility. Not having a signed DNR puts all the responsibility on the POA and gives him/her no flexibility. (I hope I’ve adequately described the point.)
Ted and I talked about our preference for the POLST form to a simple DNR form. POLST stands for Physician Orders for Life-Sustaining Treatment. It is signed by an MD, and serves as an MD’s instructions for what sorts of treatment anyone has determined he/she wants to have. Paramedics, RNs, and MDs will accept and take instructions from the POLST.* The POLST goes through a few more scenarios than just the person-is-not-breathing-and-ha
You can find general info on POLST at polst.org; this is a national effort that started at Oregon Health & Science University. The POLST has recently become usable in California. State-licensed facilities are now being required to have a POLST form on all residents. [Editor’s note: you can now find California’s form at capolst.org.]
The POLST is a great form of anyone with a neurodegenerative condition or terminal illness to have completed and signed by his/her MD.
For the non-neurodegenerated, there’s the Advance Health Care Directive. In our state, the California Medical Association has an Advance Health Care Directive Kit. The cost is $5. I have a few more free copies left; let me know at the next support group meeting if you want to get a copy from me.
This question-and-answer from the California Medical Association website may be of interest:
#18 Q: I have reached a point in my life that I don’t want the paramedics to give me CPR. Will this Advance Health Care Directive keep this from happening?
#18 A: If the paramedics are made aware of your Advance Health Care Directive before they start resuscitative efforts, and the Advance Health Care Directive clearly instructs them not to start these efforts, your wishes should be respected. You may also want to complete the “Prehospital Do Not Resuscitate (DNR)” form and obtain a “Do Not Resuscitate– EMS” medallion approved by California’s Emergency Medical Services Authority. You may order copies of the DNR form (which includes instructions on ordering the medallion) from CMA publications.
If someone signs a DNR form, it means that they do not want CPR used. The DNR form for use in California can be ordered from the California Medical Association. The cost is $2. The CMA has a two-page brochure on the effectiveness and risks of CPR.
As for the Five Wishes document…. As far back as 2005, one of our founding group members, Storme, discusses it at most support group meetings she attends. She has completed the form herself, and worked with her mother to complete the form. Hearing Storme, many other group members have completed the form, including me. More recently, I heard Dr. Melanie Brandabur, a neurologist at The Parkinson’s Institute in Sunnyvale, recommend it.
Five Wishes is useful to fill out, and review with your healthcare POA. This presents many scenarios, describing in detail things you may and may not want. It addresses your medical, personal, emotional and spiritual wishes. It is an invaluable resource for your healthcare POA, if you are unable to communicate your wishes. The cost is $5.
Beneath my name, I’ve provided all the links you’ll need. Here’s where you can get general info, find the POLST form for CA, learn about Five Wishes, order the CMA AHCD Kit, order the DNR form, and all the stuff described above.
Happy planning!
Robin
* Paramedics and RNs cannot take instructions based on a Living Will and they may not take instructions from any other Advance Directive you may have. In the absence of a DNR or POLST, paramedics may be required to perform CPR if they have no MD’s orders to the contrary.
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POLST:
polst.org
Patients and Families FAQ on POLST:
www.ohsu.edu/ethics/polst/pati
POLST form for CA:
[Editor’s note: the form is now at capolst.org]
Five Wishes from Aging with Dignity: (cost is $5)
www.fivewishes.org/
Info on the CMA Advance Health Care Directive Kit:
www.cmanet.org/publicdoc.cfm?d
View a “Sample” Copy of the CMA AHCD Kit: (unfortunately you can’t print a usable copy)
www.cmanet.org/upload/AdvDir20
Order the CMA AHCD Kit: (cost is $5)
www.cmanet.org/bookstore/produ
Order the Pre-Hospital Do Not Resuscitate (DNR) form: (cost is $2)
www.cmanet.org/bookstore/produ
View the CMA’s brochure on CPR:
www.cmanet.org/upload/cma_cpr_
Family Caregiver Alliance Fact Sheet on end-of-life decision making:
www.caregiver.org/caregiver/js