Listen, you might not want to think about it but it’s best you get your wishes settled BEFORE you are on death’s door. Once you get over 65 it’s best to spell things out in clear language. I am talking about end of life care – and I mean you need details. What do I mean? Well, since there is no standardization across states, hospitals, nursing homes, etc, you need to spll out clearly what you want done when you are going down the tubes. For example,
1). DNR – means “Do Not Resuscitate” – but there is not an official definition of this. It is generally taken to mean if one’s heart stops, you don’t try to restart it. But there is more to it than that. Do you want everything possible done up until that point? Besides no CPR and Defibrillation, what else don’t you want? Meds? IVF? Pressors?
2). DNI – means “Do Not Intubate” – that is pretty straightforward. Don’t tube me and put me on a vent. However, some people take DNI to be part of DNR – thus it may be assumed if you are DNR that you are also DNI. Other times, you might want to be DNI but since it was not specifically spelled out on your paperwork, you might get tubed even though you are not in full arrest – and you might not want that.
3). DNT or DNH – “Do not Transfer or Don Not Hospitalize” – usually part of a hospice situation however you theoretically can be DNT but not DNR or DNI (some nursing homes can handle vented patients) . Spell it out!
4). Palliative Care Only- in addition to DNR and DNI, palliative care is only to make someone comfortable and not to try to cure or stabilize anything. Theoretically you can be palliative care only but not be DNT or DNH.
Basically, have your lawyer spell it out so medical staff (and especially EMS) can easily know what you want and don’t want. Have you health care proxy’s cell phone number on the paper so they can be called in an emergency. Tell us you don’t want to be defibrillated or have your chest compressed but since you are not a vegetable and just have bad CHF, you would accept a temporary intubation until you get diruesed. Also, make sure your health care proxy is not a nut job. Not only should they understand your wishes but they have to be sane and not a nightmare for health care professionals to deal with. Chose well.
Otherwise you risk either being allowed to die against your wishes or NOT being allowed to die against your wishes!