Life, in all its unpredictable beauty, brings with it many decisions. Some of these decisions revolve around joyous occasions—like where to travel or what career path to pursue. Yet, other choices, particularly those surrounding end-of-life care, can feel more challenging to address. While such topics might seem daunting, there’s immense empowerment in understanding and preparing for them. By making informed decisions, we ensure our desires are respected and we relieve our loved ones from making difficult choices on our behalf during emotionally charged moments.
DNRs and POLSTs represent two crucial tools in this journey of preparedness. These documents not only guide medical professionals but also serve as a testament to our self-awareness and our commitment to living life on our terms, even in its twilight moments.
In this article, we aim to shed light on what DNRs and POLSTs are, how they differ, and the steps to create them. Embracing the knowledge of these tools is an essential step in affirming the value we place on autonomy, clarity, and the well-being of those we hold dear.
For those short on reading time, here is a quick summary of the information that you should know:
- DNR (Do Not Resuscitate):
- Purpose: A directive that ensures no CPR is performed if one stops breathing or their heart stops.
- Usage: Primarily used in hospitals and clinical settings.
- POLST (Physician Orders for Life-Sustaining Treatment):
- Purpose: A detailed medical order outlining specific treatments one wishes or does not wish to receive towards the end of life.
- Usage: Applicable across various healthcare settings, from hospitals to home care.
- Key Difference:
- While both address end-of-life treatments, DNRs are limited to resuscitation decisions. POLSTs provide broader directives for multiple medical interventions.
- Creating Them:
- Discuss with a healthcare professional to understand options and ensure your decisions are accurately reflected.
What is a DNR (Do-Not-Resuscitate)?
A DNR is more than just a document; it’s a reflection of one’s personal choice regarding the specific medical intervention of resuscitation. Let’s delve into what this means.
What Exactly is a DNR?
At its core, a DNR is a directive stating that cardiopulmonary resuscitation (CPR) should not be performed if a person stops breathing or if their heart stops beating. It ensures that the medical team knows and respects the individual’s wish not to undergo this particular life-saving measure.
When and Where is a DNR Applicable?
DNRs are primarily relevant in hospital settings. If a patient experiences cardiac or respiratory arrest, medical professionals will typically initiate CPR unless a DNR is in place. Outside of hospitals, emergency medical personnel, such as paramedics or EMTs, also respect DNRs.
Making the Decision for a DNR:
Deciding on a DNR is deeply personal. It should stem from discussions with loved ones, healthcare providers, and, when possible, legal professionals. It’s crucial to understand the implications fully, both emotionally and medically. Some opt for DNRs because of the potential risks and side effects associated with CPR, especially when they have chronic or terminal illnesses. Others may choose it based on quality-of-life considerations.
Legality and Acceptance:
DNRs are legally accepted across all states. However, the exact form and process to establish a DNR might vary slightly. It’s usually part of an advanced care directive, which might also include other specifications like living wills or healthcare proxies.
Reviewing and Updating a DNR:
Life situations and health conditions evolve, and one’s choices regarding a DNR might change too. It’s essential to revisit and review this decision periodically, especially after significant medical or life changes. This ensures that the directive aligns with the individual’s current wishes and circumstances.
What is a POLST (Physician Orders for Life-Sustaining Treatment)?
A POLST ensures that an individual’s preferences regarding certain medical treatments are respected across all settings. Let’s unfold the essentials of a POLST.
What Exactly is a POLST?
A POLST is a standardized medical order form that specifies which types of life-sustaining treatment a patient wants or doesn’t want if they become seriously ill or frail. It’s meant to complement an advance directive, not replace it. The primary difference? While an advance directive provides general guidelines, a POLST gives clear, actionable medical orders.
When and Where is a POLST Applicable?
POLSTs are relevant across the entire spectrum of healthcare settings—hospitals, nursing homes, home care, or in the hands of emergency personnel. Regardless of the location, the medical orders on a POLST form are valid and must be honored.
Creating a POLST:
Crafting a POLST involves a comprehensive conversation between a patient and a medical professional, usually a doctor or nurse practitioner. This dialogue ensures the patient understands the medical choices available to them, given their current health status.
Legality and Acceptance:
POLST forms are recognized in many, but not all, states. Each state might have its specific name and variation of the POLST, but the core principle remains the same. It’s crucial to be familiar with your state’s stance on POLSTs.
Reviewing and Updating a POLST:
As with all medical directives, revisiting your POLST is essential. If health conditions or personal preferences change, the POLST should be updated to mirror these changes. It ensures that the individual receives the care they desire, aligned with their current circumstances.
Key differences between a DNR and a POLST
A “Do Not Resuscitate” (DNR) order and a “Physician Orders for Life-Sustaining Treatment” (POLST) form both serve crucial roles in medical decision-making, particularly at the end of life, but they are distinct in their purposes and scope. A DNR order is a specific directive that solely prevents healthcare providers from performing cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. It doesn’t address other medical interventions or treatments.
On the other hand, a POLST form provides comprehensive guidance on a variety of medical interventions, not just CPR. It includes directives related to intubation, antibiotic use, feeding tubes, and more, depending on the individual’s health condition and wishes. A POLST is a detailed, actionable plan crafted in partnership with a healthcare provider, offering a broader overview of a patient’s desires regarding their care. While both DNR and POLST aim to respect patient autonomy, the POLST’s more extensive scope ensures that a wider range of medical decisions align with the patient’s values and preferences.
How do I create a DNR or a POLST?
Both DNR orders and POLST forms have established processes for creation, ensuring that patient wishes are accurately represented and can be acted upon by medical professionals.
To obtain a DNR order, a discussion with a healthcare provider is essential. It’s usually the physician who provides the DNR after discussing the patient’s medical condition and their wishes regarding resuscitation. Once agreed upon, the DNR order is added to the patient’s medical record. It’s a good idea for the patient or their caregiver to keep a copy handy, especially if they move between healthcare facilities. This is a perfect use case for WayWiser’s Family Vault.
Creating a POLST form is a bit more involved given its comprehensive nature. The process begins with a detailed conversation between the patient and their healthcare provider. This conversation delves into potential medical scenarios and the patient’s preferences for each. Once decisions are made, the healthcare provider completes the POLST form, which then becomes a part of the patient’s medical record. It’s designed to be portable, meaning the patient should keep it accessible, such as on their refrigerator or with their other important documents. In many jurisdictions, POLST forms are brightly colored to ensure visibility and quick access in emergencies.
It’s essential to note that regulations and processes might vary depending on the state or country, so it’s crucial to consult local guidelines and professionals when considering either document.
Keeping track of a DNR or POLST
Navigating end-of-life decisions and ensuring that our wishes—or those of our loved ones—are respected can feel overwhelming. Yet, understanding tools like DNR orders and POLST forms can make a significant difference. These documents act as clear communicators to medical professionals about our desires when we might not be able to convey them ourselves.
Creating these documents before they are needed and being sure they are stored in a secure, easy to access place is key.
We recommend having a printed copy stored in a safe place at home—somewhere that would be the first thought for a loved one to look in case of an emergency like a desktop file.
More importantly, it’s crucial to store digital copies of a DNR and/or POLST in on a secure and shareable platform such as WayWiser so that it can be accessed anywhere