DNR, DMOST, and AHCD: Understanding Medical Directives
Most people are familiar with common estate planning documents like Wills, Trusts, and Powers of Attorney. However, there are other crucial documents that should be part of your comprehensive estate plan. This article focuses on three frequently used, yet often confused, documents related to your healthcare decisions: the Do Not Resuscitate (DNR) Order; the Delaware Medical Order for Scope of Treatment (DMOST); and the Advance Health Care Directive (AHCD).
These documents allow you to express your healthcare preferences in advance. Should you become incapacitated or unable to communicate, these directives guide your medical team in honoring your wishes.
1. Do Not Resuscitate (DNR) Order
The DNR is a medical order that informs healthcare providers that you do not want cardiopulmonary resuscitation (CPR) if your heart stops or you cease breathing independently. Typically offered by hospitals or treatment facilities before procedures, a DNR is specific to that particular admission or treatment. There are other settings where a DNR might be offered and honored, like while receiving hospice care in a facility or at home.
Healthcare providers will attempt resuscitation unless directed otherwise by a DNR (or a DMOST, discussed below). If you choose not to be revived, your physician can place the DNR in your medical chart to inform staff of your preferences.
2. Delaware Medical Order for Scope of Treatment (DMOST)
Introduced in 2015, the DMOST is Delaware's newer, more comprehensive form. It's designed for patients with terminal illnesses or those with a life expectancy of one year or less. Unlike a DNR, which is typically specific to one hospital admission, a DMOST is a standing order that follows you throughout your treatment journey.
The DMOST provides more detailed instructions than a DNR. While it can indicate your preference not to be resuscitated, it also allows you to express your wishes regarding other aspects of treatment, such as life support or organ donation. This form is particularly useful for terminally ill patients who may transition between various medical settings, from ambulances to hospitals to hospice care.
3. Advance Health Care Directive (AHCD)
The AHCD is the most comprehensive of these documents. Ideally, you should create an AHCD when you're younger and healthy—anyone 18 or older of sound mind can draft one with legal assistance. This document provides peace of mind, ensuring your wishes are established should an unexpected medical crisis occur.
An AHCD conveys similar information to a DMOST but also allows you to appoint a healthcare Agent(s) to act on your behalf if you become medically unable to do so. This is similar to appointing a Trustee in your Trust to manage your affairs during incapacity or after death. If you become physically unable to communicate with your treatment team or mentally unfit to make decisions, your appointed agent can step in, guided by the preferences outlined in your AHCD.
Important Considerations:
1. Regular Review: Since it's advisable to create an AHCD when you're young and healthy, review it every 3-5 years. Your end-of-life care preferences may change over time, as may relevant laws. Additionally, the person you choose as your Agent when you're 35 might not be the best choice 20 years later.
2. Legal Counsel: While the DNR and DMOST forms are with your physician, an AHCD should be created with legal guidance. Seek assistance from a trusted law firm specializing in estate planning and elder law.
3. State-Specific Laws: Be aware that laws governing these documents can vary by state. If you move to a different state, review your directives with a local attorney to ensure they remain valid and align with local regulations.
4. Communication: Once you've created these documents, inform your family members, healthcare providers, and appointed Agent(s) about their existence and location. Consider keeping copies in easily accessible places and with trusted individuals.
Conclusion:
Whether you opt for a DNR, DMOST, AHCD, or a combination, these documents provide crucial guidance for your medical care. They offer peace of mind to you, your appointed Agent, and your medical team, ensuring your wishes are honored during critical times. As with all aspects of estate planning, consult with legal and medical professionals to make informed decisions that best suit your individual circumstances.