Resources to plan for end-of-life care.

 

Advanced Health Care Directives

You can use Advanced Health Care Directives to tell EMTs, doctors and hospitals how you want to be cared for when you are no longer able to make decisions on your own.
 

• Do Not Resuscitate (DNR) Orders

• Living Wills

• Durable Power of Attorney for Healthcare (DPOAH)
   

Hospice / Palliative Care

Supportive healthcare treatment for people who have a serious chronic illness or are terminally ill, focused on easing the symptoms of the disease, and includes pain management, and emotional and spiritual support.
 

Advanced Health Care Directives

You can use Advanced Health Care Directives to tell EMTs, doctors and hospitals how you want to be cared for when you are no longer able to make decisions on your own.

Important Notes:
 

• EMTs must be given your DNR order or you must be wearing a DNR bracelet or necklace for your resuscitation to be withheld.

• Only a physician can issue a DNR order.

• Living wills and Durable Powers of Attorney for Healthcare are not substitutes for a DNR Order.
   

Where can I get more information about Advanced Health Care Directives?

We’ve provided some basic information below, including how to ensure that your wishes are followed by EMTs when you are at home or at an assisted living facility.

 

Two other good resources for more information are:

The Foundation for Healthy Communities in New Hampshire Advanced Care Planning Guide.

American Association of Retired People (AARP) Website.

 

Where can I get blank Living Will and Durable Power of Attorney forms?

The Foundation for Healthy Communities in New Hampshire makes these documents available in their Advanced Care Planning Guide.

 

Where can I get a blank DNR form?

You can only get a DNR order from your physician. The order must be signed by your physician to be effective. You can view an example here.

 

What are the different forms of Advanced Health Care Directive?

 

Do Not Resuscitate (DNR) Order

This is a medical order written by a physician that tells EMTs and doctors not to perform extraordinary efforts, such as CPR and intubation, in an effort to resuscitate you if you die. In the event that your heart stops beating and you stop breathing, an EMT will normally perform CPR to try to restart your breathing and heartbeat. You may decide that you do not want CPR performed. New Hampshire has a specific DNR form that should be used. To have your wishes honored by an EMT, you must be wearing a DNR bracelet or the EMT must be given your DNR order. A Living Will or a Durable Power of Attorney for Healthcare is not a substitute for a DNR order.

 

Living Will

A Living Will instructs your health care provider to give no life-sustaining treatment if your death is inevitable or you are permanently unconscious, without the hope of recovery. A Living Will will not prevent EMTs from performing CPR or other resuscitation in the event you suddenly suffer cardiac arrest at home or in a nursing home; you must also have a DNR order in place.

 

Durable Power of Attorney for Healthcare

In a Durable Power of Attorney for Health Care, you give someone else (e.g. your spouse) the power to make medical decisions for you if you become incapacitated. You can include instructions about which treatments you do or do not want, or how long you want to try possible treatments. The person you designate as your health care agent cannot prevent EMTs from performing CPR or other resuscitation in the event you suddenly suffer cardiac arrest at home or in a nursing home; you must also have a DNR order in place.

 

What is the difference between a DNR order and an Advance Directive (Living Will or DPOAH)?

The differences between a DNR and an advance directive include: an advance directive is not a medical order, even though it is a legally recognized document, while a DNR order is a medical order; a DNR order applies only if your heart stops beating and you stop breathing, while an advanced directive deals with many other medical issues and decisions, such as whether to provide medically assisted feeding or hydration.

 

I have a DNR order from another state. Is it effective in New Hampshire?

The best course to ensure that your wishes are followed is to obtain a valid New Hampshire DNR order. The New Hampshire law does not expressly address the validity of out-of-state documents. If your out-of-state DNR order is substantially similar to the New Hampshire form, there is a good chance that your wishes will be respected. For further information, please consult with your attorney or physician.

 

I have a Living Will or a Durable Power of Attorney from another state. Is it valid in New Hampshire?

 

Yes.

 

How will EMTs know that I have a DNR order?

They will only know if when they arrive onscene they are given your DNR order or you are wearing a DNR bracelet or necklace.

 

Can’t my wife or the nurse simply tell the EMTs that I have a DNR order?

No. We must see the actual DNR order or you must be wearing the DNR bracelet or necklace.

 

The hospital has all of my DNR and other paperwork. Can’t you call the hospital?

No. We must see the actual DNR order or you must be wearing the DNR bracelet or necklace.

 

Do I need an attorney?

You do not need an attorney to create an advance directive document. You can simply use the forms provided by the NH Foundation for Healthy Communities. If you have questions, you can talk with an attorney or staff from your doctor’s office, hospital or hospice.

 

Hospice Care

Supportive healthcare treatment for people who are terminally ill. Hospice care addresses the physical, emotional, and spiritual needs of the dying patient and family members. The focus is on caring, not curing. It is focused on easing the symptoms of the disease, and includes pain management, and emotional and spiritual support. For more information, go to AARP’s website.

 

Palliative Care

Palliative care is for patients who have chronic or life-threatening illnesses such as heart disease, chronic obstructive pulmonary disease (COPD), diabetes and AIDS. It offers a range of services that improve the patient's overall quality of life. It is focused on easing the symptoms of the disease, not curing it, and includes pain management, and emotional and spiritual support. For more information, go to AARP’s website.