Allow Natural Death and Do Not Resuscitate Orders
Allow natural death (AND) and do not resuscitate (DNR) orders are written by a healthcare provider. A DNR informs medical staff that CPR should not be attempted. This also means other resuscitative measures, such as electric shocks to the heart and breathing support, will also be avoided. DNR orders are useful in preventing unnecessary and unwanted invasive treatment at the end of life. A DNR order does not mean “do not treat.” Other treatments like antibiotics, dialysis, and medications that can prolong life may still be provided. DNR instructions in your advance directive may not be effective if you receive emergency care, such as in the event of a sudden collapse. If you do not want resuscitation attempted under any circumstance, you need a form that is separate from your advance directive, sometimes called an “out-of-hospital DNR.”
Out-of-Hospital DNR Orders
All states allow special DNR orders that are effective outside a hospital setting. These are called “out-of-hospital,” “pre-hospital, comfort care” or “no CPR” orders. Generally they require the signature of a healthcare provider and the patient (or their authorized surrogate decision-maker).
You may also consider a quick way to convey these wishes by wearing an emergency bracelet or necklace.
First responders are almost always required to initiate life support unless a valid DNR order is in place (meaning it has been signed by a healthcare provider) and is immediately presented to them. To learn more about what you need to do to ensure that paramedics comply with your out-of-hospital DNR, you can call your local ambulance service or fire department.
Physician/Medical Orders for Life-Sustaining Treatment (POLST OR MOLST)
Most often called POLST, but sometimes MOLST, physician or medical orders for life-sustaining treatment is a document that captures the discussion and shared decision-making process between a healthcare provider and person living with advanced or end stage illness. They are a means to translate your advance directive into healthcare provider orders to be followed by all medical personnel. Your healthcare provider may use the POLST form to write orders that reflect the types of life-sustaining treatment, such as CPR or tube-feeding, that you do or do not want given your medical situation.
POLST orders are not for everyone. Only patients with an illness or frailty serious enough that a healthcare professional would not be surprised if they died within one year should have them. For these patients, their current health status indicates the need for standing medical orders. For healthier patients, an advance directive is a more appropriate tool for making future care wishes known.
To learn more, speak with your healthcare provider or visit The National POLST Coalition for the latest information on POLST planning in your state: Polst.org.
In the Toolkit: You can add My Particular Wishes and Dementia Provision forms to your advance directive to provide more detail about your preferences regarding specific interventions. Download the Toolkit.
Advance Directive Addendum: My Particular Wishes for Therapies That Could Sustain Life
You can include more detail about your wishes regarding specific life-sustaining interventions in your advance directive by completing this Compassion & Choices form, included in the toolkit. It lists a range of treatments, including the life-support interventions described previously. For each listed treatment you can check that you consent to the treatment, consent to a trial period, or refuse it. You can also use the form as a basis for discussion.
Dementia Advance Directive
The Dementia Values & Priorities Tool® is designed to help you communicate your wishes regarding future care if you are living with dementia. After answering a series of questions related to the changes commonly seen in the progression of dementia, you will have a document that can be added to your existing advance directive and shared with others.
The interactive online tool is available in English and Spanish, and a printable version is available in multiple languages. Be aware that not all memory care or long-term care facilities will honor such a directive, so you’ll want to explore the issue before you are admitted. To lessen the chance your preferences will be challenged, you may also consider using your phone, tablet, or digital camera to record a statement explaining why you have completed a dementia directive, and making clear that you have made your decision without pressure or coercion. Be sure to share that file with loved ones and/or your medical proxy.
To complete a fully customizable dementia advance directive, visit CandC.org/dementiavalues-tool.
