Advanced Directive: Things I didn’t Know

Next week I’m going in for a cortisone injection in my back. The purpose is to break an inflammation/pain cycle having to deal with this and then finish my round of physical therapy.

While filling out the standard new-doctor’s-office forms, I was forced to accept several documents before proceeding. These forms were HIPAA and Privacy and this one:

ADVANCED DIRECTIVE
Marietta Surgical Center is not an acute care facility; therefore regardless of the contents of any advanced directive or instructions from a health care surrogate or attorney, if an adverse event occurs during your treatment, we will initiate resuscitative or any other stabilizing measures & transfer you to an acute care setting for further evaluation. Your agreement with this policy does not revoke or invalidate any current health care directives or health care power of attorney.

I found this fascinating. They will not honor a Do Not Resuscitate request (DNR) or other advanced directive at this office. As I’m hardly an expert on the topic, I decided to brush up at Wikipedia. Here are the money quotes:

A DNR does not affect any treatment other than that which would require intubation or CPR.

Continuing:

In the United States the documentation is especially complicated in that each state accepts different forms, and advance directives and living wills are not accepted by EMS as legally valid forms.

And further:

In the U.S., cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) will not be performed if a valid written “DNR” order is present. Many US states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures unless a specific state sponsored form is appropriately filled out and cosigned by a physician.

I learned something today (That means I get to go home, right?). I learned that DNRs and Advanced Directives are not synonymous. I learned that DNRs are complex little beasties requiring physician sign-off on the correct forms, and might not be followed anyway.

What does this mean for me? Not much, really. If I suddenly go into cardiac arrest while they’re sticking a needle in my back, they have full permission to revive me. But it does increase my basic bureaucratic knowledge in case a DNR or Advanced Directive is something I have to deal with later, so win–win.

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