Downs Law Firm, P.C.

natural end

A Natural End of Life

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You know that you can always refuse life-sustaining medical treatment. The tricky part comes when you are no longer able to understand your options or communicate your wishes to the health care professionals.

Many people I meet with want to have a natural end of life.

If you want to control your demise, there are a handful of documents that are typically created during the process of developing an estate plan that can be used to achieve this goal, says the article “Choosing a natural end” from The Dallas Morning News.

The four documents are the Medical Power of Attorney, the Directive to Physicians, the Out-of-Hospital Do-Not-Resuscitate, and the In-Hospital Do-Not-Resuscitate. Note that every state has slightly different estate planning laws. In Maryland, we rely on three documents: a Living Will, a Health Care Power of Attorney, and a MOLST form (Medical Orders for Life-Sustaining Treatment).

The first two come in many shapes and sizes, with differing names: an Advanced Directive or “Five Wishes” statement are common variations.

For a Health Care Power of Attorney, you are appointing an agent to make health care decisions if you cannot. This may include turning off any life-support systems and refusing life-sustaining treatment. Talk with the person you want to take on this role and make sure they understand your wishes and are willing and able to carry them out. Also, send them a scan of the document so it is readily available.

You have the right to change your agent at any time.

A Living Will, also referred to as a “Directive to Physicians,” is a way for you to let physicians know what you want for comfort care and any life-sustaining treatment in the event you receive a diagnosis of a terminal or irreversible health condition. You aren’t required to have this, but it is a good way to convey your wishes. The directive does not always have to be the one created by the facility where you are being treated, and it may be customized to your wishes, as long as they are within the bounds of the law. Many people will execute a basic directive with their estate planning documents and then have a more detailed directive created when they have a health crisis.

The Do-Not-Resuscitate (DNR) forms come in two different forms in most states. Unlike the Directive to Physicians, the DNR must be signed by your attending physician, a physician’s assistant, or a registered nurse. The Out-of-Hospital DNR is a legally binding order that documents your wishes to health care professionals acting outside of a hospital setting not to initiate or continue CPR, advanced airway management, artificial ventilation, defibrillation, or transcutaneous cardiac pacing. You need to sign this form, but if you are not competent to do so, a proxy or health care agent may sign it.

The In-Hospital DNR instructs a health care professional not to attempt CPR if your breathing or heart stops. It is issued in a health care facility or hospital and does not require your signature. However, the physician does have to inform you or make a good faith effort to inform a proxy or agent of the order.

The MOLST form or DNR are important tools to see that you have a natural end of your life. Such an election is supposed to be signed by a medical professional because they can counsel you about the appropriateness of your selection based on your medical condition. This may be entirely appropriate for someone with a life-threatening illness. I often find they are handed out out like jelly beans at senior centers, with no consideration of medical condition or appropriateness.

If you would prefer to have a natural end of life instead of spending your final days or hours hooked up to medical machinery, speak with your estate planning attorney and treating physician about how to legally prepare to protect your wishes.

Reference: The Dallas Morning News (Jan. 12, 2020) “Choosing a natural end”