Understanding Advance Directives

The topic of Advance Directives has become an increasingly important subject for families to consider when placing a loved one in a long term care facility.

What is an Advance Directive?

The concept of advance directives is rooted in the ethical principle of patient autonomy. By formally specifying and stipulating care preferences (living will) and/or naming a proxy for making health care decisions (durable power of attorney for health care), patients can maintain more autonomy during periods of incapacity and at the end of life.

In an Advance Directive, the individual is declaring to their loved ones how they prefer to be treated when they are no longer capable of speaking for themselves. It’s a gift to those who are left behind to know what they should do to best meet the wishes of their loved one.

To fully understand how advance directives work, it’s important to understand what they mean and how one or the other (or both) are used.

There are many terms that are bandied about when it comes to Advance Directives, but two of the most important are:

• Do Not Hospitalize (DNH) – Many people misinterpret this directive, but ‘do not hospitalize’ does not mean ‘do not treat’. This is a common fallacy and misconception. Having a DNH order does not mean the patient won’t receive treatment; it simply means she/he will not be sent to a hospital for treatment. Not hospitalizing your loved ones can mean not sending them into a series of confusion and setbacks due to their current condition.
• Do Not Resuscitate (DNR) – Some people misunderstand this order as withholding life-saving medical treatment. A DNR is a legal order that expresses the wishes of the patient not to undergo CPR or advanced cardiac life support if their heart were to stop or if they were to stop breathing. This type of request is about allowing natural death.

As part of the charting for nursing home residents, social workers will discuss (and subsequently document) these important issues with families to develop a clear understanding as to their wishes and preferences.