DOPA’s, Living Wills, DNRs…What Does it all Mean?

Posted August 29, 2012 by Franciska Kiraly, M.D.

I wanted to share something that came up in my own family a few weekends ago. It's one of those things people don't like to talk about — much less think about — but it's important. My great uncle is in his late 80's, frail and weak with many medical problems. He recently went to the hospital after falling at home.

During his hospital stay, he became confused; and one of his healthcare providers mentioned that he might need to be transferred to the intensive care unit. His wife became concerned because as she said, "He wouldn't want any heroic measures." And then she said the words I've heard so often — "We have a living will."

Let me pause there. When she said they have a living will — honestly, all that translates to in my head is, "We've thought about what we'd want done if we were seriously ill." That's great, and it's definitely a start. But when you're in the hospital, you have people taking care of you who don't know all of your wishes. As a physician in an emergency, I can't sit down to flip through five to six pages of information, hoping to figure out what you'd want done. Living wills are long and complicated, only addressing a limited set of circumstances. I may get a general idea of your desires should a severe problem arise and know that you've at least talked about a living will; but that may be all I can determine.

So how do you convey to your healthcare providers what you'd want done when you can no longer express it? I'll explain a few key pieces of lingo we use, and how they can help you and your loved ones.

• DPOA (Durable Power of Attorney for Healthcare): This is the single most important step to take to assure that your wishes are followed — something we should all have right now. Also called a healthcare proxy, this is someone we choose to speak for us when we cannot speak for ourselves regarding healthcare decisions. When deciding who you'd want to be your DPOA for healthcare, choose someone over the age of 18 you are comfortable talking with, who would carry out your wishes under difficult circumstances, and is someone you can trust on a basic level. Let your doctor know who you've designated. Most importantly, find the time to sit down with your DPOA and discuss what you would want or not want done in a severe situation. Provide some context around your decisions, and let them know why and what led you to that choice (i.e. experiences other friends and family members may have had).
• Living wills: These are seen as written instructions for what someone would want or not want done. Often, these include what you'd want in the long-term when you cannot express your decisions or speak with your healthcare providers in an emergency. Because there is so much gray area in medicine, living wills are difficult to understand what you'd want done emergently.
• DNR (Do Not Resuscitate): This is a request not to have CPR (Cardiopulmonary Resuscitation) attempted if you were to stop breathing and your heart stopped. When someone is in the hospital, we will often ask if they would want CPR and other measures. This can be a rather unnerving question if you had never thought about it before. And although difficult, the best time to think and talk about these things is not when you are sick.

In tomorrow's post, we'll talk about the chances of success with CPR, and I'll provide some examples for you to consider.

Franciska Kiraly, M.D.
Hospice and Palliative Medicine Fellow
Summa Health System