End-of-Life Decision Making

If nothing else, the Terry Schiavo case teaches society that patients must make their end-of-life health-care wishes clear to loved ones and that the wishes must conform to the state’s legal requirements in order to be honored.

There are two mechanisms to let end-of-life decisions be known : advance directives and do not resuscitate orders (DNRS).

Advance Directives

An advance directive is the legal document through which end-of life decisions are memorialized and honored by the judicial system. The advance directive is usually a combination of a living will and a durable power-of-attorney. A living will contains information on the types of care that are acceptable to the person should they become incapacitated. A durable power-of-attorney designates the person who will make medical decisions for someone who is incapacitated and unable to make their own decisions. The person selected should be someone trusted to follow the wishes as expressed in the living will. The person selected should agree to this responsibility. Once the legal documents are complete, provide copies to the selected person, to family members, and to physicians. In addition, review these documents regularly. ÿAdvance directives can be created at any time and do not have to be signed by a physician to become effective.

MSNJ worked with a variety of organizations including the American Association of Retired Persons (AARP), the New Jersey Division on Aging, the New Jersey Office of the Public Advocate, the New Jersey Office of the Public Guardian, the New Jersey Hospital Association, and many religious organizations to create an extensive booklet entitled, “Advance Directives for Health Care: Planning Ahead for Important Health Care Decisions.” The booklet was prepared by the New Jersey Commission on Legal and Ethical Problems in the Delivery of Health Care and its Task Force on Public and Professional Education. The booklet can be downloaded here in a PDF format.

Do-Not-Resuscitate Orders

Do-not-resuscitate orders (DNRs) have long been accepted in hospital settings. These are medical orders and, unlike advance directives, must be signed by a physician. In the past, these orders were not available in situations in which a patient was bed-ridden at home, attended to by an emergency medical specialist (EMS), or in transport to a hospital. To address these situations, MSNJ and other interested groups developed out-of-hospital DNR guidelines to help ensure that patients whose end-of-life wishes are clear would have those wishes honored. The out-of-hospital DNR guidelines and a brochure for healthcare professionals, patients, and families can be downloaded here. The guideline document contains a DNR form and instructions for EMS or other first responders.

Below are links to web sites that contain information and forms that are helpful for end-of-life decision making:

American Medical Association
Advance Directives

American Bar Association
Detailed tools for decision making

Center for Practical Bioethics
Detailed tools for decision making

National Hospice and Palliative Care Organization
State-specific forms and instructions for advance directives

New Jersey Department of Health and Senior Services (DHSS)

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