What is the difference between a Living Will and a “Do Not Resuscitate” Order?

When we meet with clients, one issue that comes up often is end-of-life care. While it’s certainly an unpleasant thought, it is important to face the possibility that you may become unable to make decisions about your healthcare at some point. Whether you suffer from dementia and gradually become incapacitated or you experience a stroke or terrible accident and the change is more sudden, if you cannot make decisions yourself, someone is going to have to take on that responsibility for you. Perhaps most importantly, whoever is making these decisions for you will need guidance on what your wishes would be in certain situations. For example, if you were in a terminal state with no hope of recovery, would you want to be kept alive artificially through assisted respiration, feeding tubes, and other mechanisms? If so, how long would you want to be kept alive?

Many people confuse the terms “Living Will” and a “Do Not Resuscitate” Order (commonly called a DNR). A Living Will is simply a statement of your wishes. In this document, you can state whether you would like to have life-prolonging procedures such as artificial nutrition and hydration continued if you were in a vegetative state with no hope of recovery. You can also state whether you prefer to be buried or cremated and give direction as to whether you would like your body or organs to be donated for either scientific or medical purposes. This document works with your healthcare power of attorney – your agent under that document must follow your wishes as laid out in the advance medical directive.

On the other hand, a DNR is a written physician’s order to withhold resuscitation from a patient in the event of cardiac or respiratory arrest. Resuscitation measures that can be withheld under a DNR Order include cardiac compression, intubation, artificial ventilation, defibrillation, and other related procedures (Virginia Code § 54.1-2982).  Instructions to implement a DNR order are typically given by whoever is legally permitted to make medical decisions on behalf of a patient in the hospital – whether that person is the next of kin as defined by Virginia law or is someone appointed under a Healthcare Power of Attorney.

While Living Wills typically remain in effect until the person who implemented it passes away or executes a new one, DNR orders typically are revoked if a patient makes a full recovery and leaves the hospital. That means that a new DNR would need to be implemented if there were another hospitalization.

Another important document that is related to both Living Wills and DNR Orders is the Healthcare Power of Attorney. This document allows you to appoint one or more people who will work with your doctors to make healthcare decisions on your behalf should you become incapacitated. An agent under a healthcare power of attorney has a variety of powers and responsibilities, including the ability to decide which course of treatment is best for you, whether you should enter a long-term care facility, and which doctors should be consulted as to your care. If you have a Healthcare Power of Attorney, your agent will be the one who decides whether to instruct the doctor to issue a DNR Order or not.

If you don’t have a Healthcare Power of Attorney, Virginia law provides for a list of priority “surrogate decision-makers.” First on the list is your guardian (if one has been appointed), then your spouse, then any adult children you may have (Virginia Code § 54.12986).  Often, this list does not align with whom many people would want making medical decisions for them if they became incapacitated.

Although no one enjoys facing the possibility that they may become incapacitated, it is important that you make your wishes known. Doing so cannot only provide reassurance to your family, because they know what your wishes are; but, it can also guarantee you have a voice in deciding who should make medical decisions for you in the event that you cannot make them on your own.

Ask Kit Kat: Westminster Kennel Club Dog Show

Hook Law Center: Kit Kat, what can you tell us about the Westminster Kennel Club Dog Show which was held last week in New York City?

Kit Kat: Well, it’s a wonderful competition that has been held 142 times! This year’s opened on Feb.11, 2019. The first Westminster Kennel Club Dog Show opened in 1877 at Gilmore’s Garden, which later became known as Madison Square Garden. The show has grown over the years from 1,200 dogs to nearly 3,000 dogs from all 50 states. Originally, a 3-to4-day competition, it is now completed in 2 days. The name “Westminster” was chosen by its founding group as a tribute to their favorite hotel and bar—the Westminster Hotel near Union Square. Though the hotel is long gone, it still lives on in the name of the dog show. The dog show in its early days focused on hunting dogs. Other than the Kentucky Derby, it is the second-oldest continuously run sporting event in the United States. This year marks the 70^th year that the event has been televised.

Not many know that the Westminster Dog Show has a junior division for dog handlers who are between the ages of 9-18. It is known as the Junior Showmanship competition. The kids themselves are evaluated, perhaps more so, than their dogs. They have to work as a team. One girl, Rylie May of Hillsboro, Kansas, is now 18, but in her first competition at a 4 H show at age 9, she competed with a 6-month old puppy, who dragged her everywhere. She’s learned a lot since then. May entered her Australian shepherd this year. They didn’t get to the finals, but she was really proud of her dog, Toby. She said, “It’s taught me a lot about responsibility. It’s a lot of hard work. It’s putting the dog’s needs before your own.” (Claudio E. Cabrera, “How the Westminster Dog Show Got Its Name,” The New York Times, Feb.12, 2019/Amy Wang,”At this Westminster Dog Show competition, it’s the humans who are judged, ”The Washington Post, Feb.11, 2019)