Getting the most out of medical directives

Jul 25, 2014

Thinking about the end of life is not something many of us want to do. But today a variety of medical directives exist that can help your family members and health care providers know your wishes ahead of time. This week, Lorraine Rapp and Linda Lowen, hosts of WRVO's health and wellness show "Take Care" interview Dr. Barron Lerner about what different medical directives do. Dr. Learner is a medical ethicist, author and professor at the New York University School of Medicine.

Loraine Rapp: Before we talk about specific advance medical directives, will you discuss why they are so important, and what role they play in treating patients who are critically ill?

Dr. Barron Lerner: We see patients who come in critically ill [and] decisions need to be made urgently about how aggressive the doctor should be.  Sometimes it’s obvious what to do or what not to do, but oftentimes it’s much more ambiguous.  In the cases where this has been discussed in advance by a patient, it gives us guidance because making decisions in the heat of the moment can be very difficult.  You can imagine a patient gasping for breath for example [or] a patient confused, and you’re trying to have a coherent discussion about what to do.  That’s really not the ideal time to have that discussion.

Linda Lowen: What are the most common forms, documents, medical directives that are currently being used?

Dr. Lerner: The three main ones are a DNR form (Do Not Resuscitate) and that is a very specific question:  If my heart stops, will the doctors try to start it up again or not?  The second one is called the living will, in which a patient writes down directions about what they do or don’t want in a particular situation.  For example, if I have no chance of meaningful recovery, please don’t do x, y, and z.  Third [is] the health care proxy form (which I think most ethicists these days would say is the most effective) in which you designate a person and a backup person to be your decision-maker when you lose capacity to make decisions themselves.  Ideally, you’ve had one or more comprehensive discussions with that person in advance to communicate your philosophy to them.

Linda Lowen: What about filling out those forms?  Can anybody do it?  Is there a legal process that’s involved?  Do you have to include an attorney, and who keeps these forms?

Dr. Lerner: In most states, you don’t have to get it notarized or have a lawyer involved.  There’s a legal document [for which] you have to have two witnesses.  The person designates one proxy, they designate a backup, they put all the demographic information in, and there [are] two witnesses.  If that is filled out properly, it is a legally binding form.  I tell my patients to spread the document far and wide, because as we know these crises always seem to occur in the middle of the night.  I tell the patient to keep a copy, I tell them to give copies to the people they have designated, [and] I tell them to give copies to their doctor.  I think these days in the era of electronic medical records, this information can also go onto the computer.  [That way a] doctor in the middle of the night going onto the patient’s record can see some language that might even be able to help them in the emergency room, and that’s great because that’s a huge advance over the old days.

More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday at 6:30p.m. Support for this story comes from the Health Foundation for Western and Central New York.

Listen next week for  more from our interview with Dr. Barron Lerner about when to stop treatment.