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Be specific about your final wishes
By J. KEITH FESTA
Question: What is the difference between advance directives and DNR (Do Not
Resuscitate)? What should I do?
Answer: Advance directives are instructions that will direct your doctor,
hospital or other caregivers as to what kind of care you would like to receive in
the event you become unable to express your desires concerning medical care in the
An example of this is if you are in a coma and unable to respond to questions
about treatment choices, the advance directives give guidelines as to what treatments
you would like followed. They may cover what kinds of treatment you don't want,
depending on how ill you are. They may also express under what conditions you may
want treatments carried out to the fullest extent.
Any advance directives must be made while you are well enough and mentally competent.
A Do Not Resuscitate order — or DNR — is one type of advance directive. DNR would
mean CPR would not be administered if your heart stops beating or you stop breathing.
Many people who request DNR have severe advanced diseases such as cancer that has
spread. Others may have organs or systems that have severely failed, like the kidneys,
liver or heart.
A health care proxy is also an advance directive. It is a person (or persons)
you choose to make your health-care decisions if you are unable to do so. The person(s)
should, of course, know your wishes very well and be someone you can trust to carry
out your wishes as stated, despite any personal views they may hold.
You can name more than one individual to make decisions jointly or you can name
one primary person and backup individuals in the event that person cannot be located
when needed. The choice is yours alone.
A living will is another type of advance directive listing your wishes. It should
be pretty explicit because the decision made on your health care will be based on
what is written — especially if you have no health care proxy. A living will does
not select someone to make the decisions for you.
Often we only think about advance directives for the elderly or seriously ill
people. However, one should consider them at other times. One of those important
times is when your child turns 18 and is considered an adult. Unless they have a
health care proxy made out in your name, you may not have the right to have a say
in their health care in case of a medical emergency.
Once your advance directives are made, you may cancel or change them at any time
as long as you are considered of sound mind to do so. You should make your changes
in writing, unless you don't have time to do so, and advise your family and physician
of your changes.
Bringing up the topic of advance directives is sometimes difficult. Usually,
it is a little easier to begin discussions when people are in relatively good health,
but many individuals still have difficulties. You and your physician can encourage
the discussion with your family that will satisfy your wishes.
(Note that you can create your Will, Power of Attorney and Living Will online at
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