Definition: A Medical Directive is an expression exercising a person’s right to accept or decline medical treatment, even if it results in death. A Medical Directive is a powerful planning tool to make decisions concerning one’s health care personally rather than leaving it up to others.
Medical Directives are typically acknowledged or exercised in a Living Will, a Health Care Power of Attorney, or a Health Care Proxy. Medical Directives can also be institution or procedure specific. In other words, a Medical Directive can be focused on the specific medical services or procedures offered by a particular health care provider. For example, you may have a Medical Directive prepared by an attorney and also have medical directives when you have a particular medical procedure or enter into a care facility. The one may be general in nature, and the other give specific directives relative to the care or procedure you are then receiving.
The point of a Medical Directive is to communicate in advance what your wishes are concerning your health care so they can be honored at a time when you may not be able to communicate. Obviously, if you are able to communicate concerning your medical treatment, you will. In the event of an accident or medical event that makes it difficult or impossible for you to communicate, your Medical Directive will express your wishes for receiving or declining particular medical treatments.
Even though Medical Directives may deal with end of life issues as well as short term medical emergencies, optimally they are prepared far in advance of any life threatening condition. Preparing Medical Directives is a vital part of any estate plan. Medical Directives are most often implemented as a separate document at the same time as a Last Will and Testament and/or Trust. A Medical Directive is best made proactively in advance of a health care event rather than in reaction to a medical incident.
A Medical Directive can address any medical decision or issue. If your condition is terminal, a Medical Directive may state your desire to withhold or discontinue medical procedures that would only result in prolonging your dying. A Medical Directive may also state your desire to be kept alive no matter what your condition or the cost. More specific Medical Directives may express your wishes concerning other medical services such as alternative healing, pain relief, antibiotics, hydration, feeding, ventilators, or resuscitation. Medical Directives may even specify spiritual or religious preferences such as whether or not you want a particular blessing or religious rite and whether you want clergy or a religious adviser to be consulted or present during medical procedures. A Medical Directive is vital if you intend to deploy any potential life restoring procedures after death.
One of the most important decisions you will make is who will make medical decisions for you in certain circumstances. This person may be called a Medical Attorney-In-Fact, a Proxy or a Surrogate. A “proxy” of any kind is a person legally authorized to act or make decisions on behalf of another person. A “surrogate” is the same thing – a person who acts in the stead or in lieu of another. In this instance, it is a person designated to make medical or health care decisions.
A Medical Directive is aimed at medical decisions. It is NOT the same as a Durable General Power of Attorney, which is typically aimed at designating an Attorney-in-Fact to make legal, financial, and property decisions.
In most instances, the answer is no, a Medical Directive is NOT the same as a DNR. In most jurisdictions, a DNR card is an official state government generated form that is obtained from the applicable local state agency. A DNR may be a type of Medical Directive, but differs in that rather than a private instrument, a DNR is implemented under express authorization or grant of permission by local government on a specific sanctioned form.
The names or labels “Medical Directive” and/or “DNR” as well as the nuances of how they are implemented or applied vary from state to state. The major label variations include: DNR (Do Not Resuscitate), POST (Physician’s Order for Status of Treatment), MOST (Medical Order for Status of Treatment), MOLST (Medical Orders for Life Sustaining Treatment), COLST (Clinician Order for Life Sustaining Treatment), POLST (Physicians Order for Life Sustaining Treatment), Medical ID Bracelets, etc.
Technically, unless you express a termination date, a Medical Directive does not expire. However, as a practical matter, if they are too old they become stale, and there may be problems in enforcing or implementing them. As a general rule, Medical Directives have a “shelf life” of roughly five years. Younger people can stretch that time frame a bit. The older one is, or the more medical issues one has, the better it is to update Medical Directives every five years. This is particularly the case where a Medical Directive is part of a larger estate plan.
Using an attorney to prepare your Medical Directive may be extremely important or complete overkill. If you are doing other estate planning such as a Trust or Last Will and Testament, your attorney will typically include a Medical Directive as part of the package. If you have so few assets that you do not require other estate planning, using an attorney for your Medical Directive may be an avoidable expense.
In general (with many exceptions), it is best to use a document prepared by an attorney on your behalf rather than the ones given out for free by medical institutions. Such institutions engage attorneys to prepare forms that benefit and protect them and which may not be consistent with your wishes.
If you have Medical Directives that are more than five years old, you should have them reviewed and updated. One of the attorneys at Durfee Law Group will review and answer questions concerning your Medical Directives at no charge. Contact us for help.
If you are NOT going to use an attorney to prepare your Medical Directives, you can find help below.
Because DNR forms are generally available for free, it is prudent to avoid the websites that want you to pay for them. Go ahead, get the free one from one of the websites listed below.
Here are links to where you can find instructions or obtain the state specific Medical Directive and/or DNR forms:
You can also click on your state to find a link to an official location specific website or form. (Please report broken or non-working links!)