Clients occasionally ask about “DNRs” and whether we prepared them as part of the estate plan during our consultations. We do not, but we do prepare living wills.[i] A living will and a Do Not Resuscitate Order, known as a DNR, are very different documents. However, many people confuse the two. They both address end of life issues and are used in different settings, according to the article “One Senior Place: Know the difference between ‘living will’ and ‘do not resuscitate’” from Florida Today.
As a quick aside, many states articulate medical decision making differently, and that comes out in estate planning. For example, some states have advanced care directives with more exhaustive instructions, others are very simplistic. For this blog’s purposes, I’m focusing on living will versus DNR.
What is a Living Will?
A living will is a statement describing a person’s wishes about receiving life-sustaining medical treatment in case of a terminal illness or irreversible if the condition is incurable. It is used when you can’t speak for yourself and gives guidance to a decision-maker who will act on your behalf. This includes choices such as whether to continue the use of artificial respiration, feeding or hydration tubes or other artificial means to prolong life.
The living will is used to make your wishes clear to loved ones and to physicians. It is prepared by an estate planning or elder law attorney, often when having an estate plan created or updated. It will be used if and when the situation arises.
What is a DNR?
A DNR is a medical directive used to convey wishes to not be resuscitated in the event of respiratory or cardiac arrest. This document needs to be signed by both the patient and their physician. It’s often printed on brightly colored paper, so it can be easily found in an emergency.
To draw the distinction a little more clearly, the living will comes into play when the doctors have done what they can and nothing else is expected to help (the terminal condition) in which case your wishes are follow, and the DNR is a request not to try and resuscitate. Most people if they are in my office want the living will, not the DNR.
The DNR should be placed in a location where it can be easily and quickly found. In nursing homes, this is typically at the head or foot of the bed. At home, it’s often posted on the refrigerator. It is also often used in hospital settings. The DNR needs to be immediately available to ensure that the patient’s last wishes are honored.
When the DNR is in effect and easily found, the emergency responders will not initiate CPR if they find the patient in cardiopulmonary arrest or respiratory arrest. They may instead provide comfort care, including administering oxygen and pain management. To be clearer, a DNR doesn’t mean doctors won’t treat you, but it means they won’t resuscitate in the event of arrest.
If a person is admitted to the hospital, their living will is placed on the chart so that it can be followed appropriately. Once a clinical determination of a terminal and irreversible condition has been made, the terms of the living will are followed.
As one more final point, clients sometimes confuse the medical power of attorney and living will. Mary did an excellent blog cover the basics of each, their differences, and why having both is beneficial. You can find that here:
Reference: Florida Today (July 19, 2022) “One Senior Place: Know the difference between ‘living will’ and ‘do not resuscitate’”
[i] In Texas, we use a “Directive to Physicians.” This is largely analogous to living wills in other jurisdictions. Since I’m writing online and to more than just a Texas audience, I’ll use the more generic term of living will.