End-of-Life Choice, Palliative Care and Counseling

Living Will Does Not Prevent Unwanted Resuscitation Attemptsby Pat Tucker

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Fortunately, an experience I had while caring for my mother turned out to be educational instead of tragic. In the interest of helping others avoid a potential disaster in end of life plans I’m sharing it with you.

 I moved my mother who was suffering from Alzheimer’s disease to Montana from her home in Washington. She brought with her a living will and an advanced directive that clearly spelled out her wish to not have “heroic” measures taken for her. I dutifully attached a copy to the refrigerator door, put a copy in her purse, informed her caretakers of her wishes, and discussed the documents with her new doctor and gave him copies. Everything taken care of, right? If my mother’s heart stopped, there would be no attempt at resuscitation, right?  Not in Montana. And don’t depend on that being adequate in other states either.

 Imagine my dismay when her caretaker called me while I was out of town and said that mom had collapsed, that she (the caretaker) had called 911 but luckily mom had recovered by the time they arrived and so there was no need for resuscitation. After further investigation I found that, in Montana, emergency responders are obligated to begin resuscitation attempts despite what a living will, a caretaker, a relative or an advanced directive may say to the contrary.

 The only way emergency responders can legally refrain from a resuscitation attempt is if the person has “Comfort One” documents on their body (bracelet or necklace), in their wallet or attached to their refrigerator door.

According to the Association of Montana Health Care Providers

 “Based upon only your living will, you do not qualify for Comfort One status. However, if you have been diagnosed with a terminal condition, you qualify. Another option for qualification is to talk with your doctor about your medical treatment preferences and decide with him your options regarding DNR status. If your physician, based on medical and ethical guidelines, can order do-not-resuscitate status for you, then you will qualify for the program. Your living will is valid only in the hospital setting. If it is presented to EMS personnel, it will be disregarded.

 Montana Administrative Rule allows only physicians, hospitals, home health agencies, hospice agencies and long term care facilities to issue forms and bracelets to patients. The ultimate source of enrollment is with your physician as Comfort One requires a physician’s signature on the form.”

 Due to Mom’s age, her mental and physical condition and her living will I was able to easily obtain Comfort One status from her physician. But who knew? Obviously her physician had not thought to inform us about this critical regulation. I cannot imagine how angry I would have been had her collapse been followed by a near certain unsuccessful attempt at resuscitation (more on the subject of resuscitation success rates next time) with all its attendant pain and suffering.

 If you know someone who does not want a resuscitation attempt, let them know that, in order for their wishes to be met, they must contact their physician and enroll in the program. If you are such a person, call your physician now! If you live outside Montana investigate your state’s regulations regarding emergency responders’ obligations to attempt resuscitation. A phone call now may prevent a nasty surprise later.