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Thursday, September 16, 2010

Opposite of DNR

Not long ago I received a question on this blog that asked me how to word a personal directive so that "the opposite of DNR" was achieved. The person didn't want "some idiot pulling the plug" and wanted to know how to word the document so that "the only reason I should be dead is old age". I've heard similar comments a number of times, so I believe this question represents the thoughts of many people.

I don't believe that there is any generic wording that suits everyone, and I am not prepared to suggest any wording of any document to someone when I don't know all of the relevant facts. However, I do want to talk about the general issues that arise from this person's question. I believe that many people don't really understand how the Personal Directive (aka heath care directive, advance directive, power of attorney for health) works.

The first thing that strikes me is that the person asking me this question shares a misconception with a number of other people I've met. That is, that signing a directive somehow gives medical professionals permission to prematurely and frivolously end someone's life. That is simply not the case,. The permission given in the directive says only that if the person is in a vegetatative state and no matter what is done, the person will never recover, then it is alright to discontinue artificial support. Nowhere are you giving permission for someone to kill you should you inadvertently fall asleep and not be able to watch your back. I doubt there are many practicing doctors out there who can't tell a functioning person from one in a  vegetative state. Personal Directives usually also contain specific instructions that direct that nutrition, hydration and pain-killers continued to be administered.

The doctors I've talked to about this tell me that if they believe that life support should be discontinued, they talk to the family and set a date for it. There is nothing hasty or spontaneous about it and there is plenty of time for the family to talk it over with each other and with the doctors.

Many people express to me a fear that the plug will be pulled too soon, and they will lose the chance to recover. As has been pointed out to me many times during these discussions, people do recover from comas. The problem here is that a person for whom life support is going to be discontinued is not in a coma. A person on artificial life support has no brain function at all. The only thing keeping them alive is a machine that pumps their heart or their lungs. What are the odds of recovery?

Also remember that the person who has the authority to speak for you on health decisions is not the doctor. Only the person you chose and named in your document may communicate your written instructions about how to handle the situation. So to have someone mistakenly try to remove life support, not only would the doctor have to be "some idiot", your chosen representative would also have to be one.

I'm glad the issue was raised, as this is one of the concerns bothering people who are trying to do their estate plans and trying to understand how the Personal directive document works.

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