It’s a common occurrence: We’re seated at our conference table with new clients and the conversation reaches the topic of advance directives for healthcare; the clients quickly say that they each want a DNR (Do Not Resuscitate) declaration. In Indiana, a true DNR is a state form titled “Out of Hospital Do Not Resuscitate Declaration and Order.” Most individuals do not meet the criteria for this form to be legally valid. The form is dictated by Indiana statute, and says the following:
“My attending physician, advanced practice registered nurse, or physician assistant has certified that I am a qualified person, meaning that I have a terminal condition or a medical condition such that, if I suffer cardiac or pulmonary failure, resuscitation would be unsuccessful or within a short period I would experience repeated cardiac or pulmonary failure resulting in death.” In other words, this is saying that you are terminally ill and would not be expected to recover well from a heart attack or similar situation. This is a narrow category of individuals AND it relies on a physician to certify that the individual meets one of the two criteria.
If you (like most people) don’t qualify for a DNR declaration, there are other options available under Indiana law. The first is an Appointment of a Health Care Representative, and the second is a POST form. Appointments of Health Care Representatives are great because they name a trusted person to step into your shoes and make medical decisions when you cannot speak for yourself. Because so many people feel strongly about end-of-life care, ours almost always give powers regarding refusal of care and end-of-life decisions. For example, most people agree that they want their chosen representative to weigh the quality of life that a procedure might provide versus only an extension of life. Other than having the legal capacity (in other words, that an attorney would conclude that the person understands what they are doing), there are no requirements or restrictions for the Appointment of Health Care Representative, and a physician does not have to sign it.
The POST form is narrower in scope than the Appointment of Health Care Representative but available to more people than a DNR. POST stands for Physician Orders for Scope of Treatment. Unlike the DNR, it may be used by individuals who fall under four different categories. As an example, one qualifying category is someone with an advanced chronic progressive illness. POST is also a state form, and it allows the person to select their preference in regards to various types of medical procedures, for instance, CPR and artificial nutrition and hydration. It, like the DNR, requires a physician’s signature.
The point of all of this is that, while most people do not qualify for a DNR, they are not out of luck when it comes to making health care declarations. Despite the confusion on terms, if your goal is to make your preferences on health care or refusal of health care known, it can be done with a properly drafted legal document — it may just have a different title than what you expected.