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ADVANCE DIRECTIVES

WHAT ARE ADVANCE DIRECTIVES?

“Advance Directives” are legal documents that allow you to plan and make your own end-of-life wishes known in the event that you are unable to communicate, and to appoint someone to make health care decisions for you, if you cannot make them yourself. An advance directive is quite similar, and is sometimes referred to as a living will or medical power of attorney.

WHAT ARE LIFE-SUSTAINING TREATMENTS?

Life-sustaining treatments are specific medical procedures that support the body and keep a person alive when the body is not able to function on its own. Making the decision about whether or not to have life-sustaining treatments can be a difficult decision depending on your situation.

You might want to accept life-sustaining treatments if they will help to restore normal functions and improve your condition. However, if you are faced with a serious life-limiting condition, you may not want to prolong your life with life-sustaining treatment. The most common end-of-life medical decisions that you, family members or an appointed healthcare agent must make involve:
-Do Not Intubate Order (DNI)
-Artificial Nutrition and Hydration
-Cardiopulmonary Resuscitation (CPR)
-Do Not Resuscitate Order (DNR)

This order is not included in an advanced directive. A DNR must be signed by a doctor, and is best done upon admission to a hospital or other medical facility

WHAT IS CARDIOPULMONARY RESUSCITATION (CPR)?

Cardiopulmonary resuscitation (CPR) is a group of procedures used when your heart stops (cardiac arrest) or breathing stops (respiratory arrest). For cardiac arrest the treatment may include chest compressions, electrical stimulation or use of medication to support or restore the heart’s ability to function. For respiratory arrest treatment may include insertion of a tube through your mouth or nose into the trachea (wind pipe that connects the throat to the lungs) to artificially support or restore your breathing function. The tube placed in your body is connected to a mechanical ventilator.

WHAT IS A DO NOT INTUBATE (DNI) ORDER?

When you request a DNR order, your physician may ask if you also wish to have a “do-not-intubate” order. Intubation is the placement of a tube into the nose or mouth in order to have it enter your windpipe (trachea) to help you breathe when you cannot breathe adequately yourself. Intubation might prevent a heart attack or respiratory arrest.
Refusal of intubation does not mean refusal of other techniques of resuscitation. If you do not want mechanical ventilation (breathing), you must discuss intubation because it may be included as part of a DNR order. Even if you have completed a DNR order that does not mean that you have refused to be intubated. If you do not want life mechanically sustained, you must discuss your decision about intubation with your doctor. In Thailand it is illegal for the hospital to remove a mechanical ventilator, once it has been installed.

WHAT IS ARTIFICIAL NUTRITION AND HYDRATION?

Artificial nutrition and hydration are treatments that allow a person to receive nutrition (food) and hydration (fluid) when they are no longer able to take them by mouth. This treatment can be given to a person who cannot eat or drink enough to sustain life. When someone with a serious or life-limiting illness is no longer able to eat or drink, it usually means that the body is beginning to stop functioning as a result of the illness.

WHAT IS A DO NOT RESUSCITATE ORDER (DNR) ?

A Do Not Resuscitate (DNR) order is a written physician’s order that prevents the healthcare team from initiating CPR. The physician writes and signs a DNR at your request or at the request of your family or appointed healthcare agent if you do not want to receive CPR in the event of cardiac or respiratory arrest.
A DNR order must be signed by a doctor otherwise, it cannot be honored. DNR orders can be cancelled at any time by letting the doctor who signed the DNR know that you have changed your decision.

A DNR order may remain in effect if you transfer from one healthcare facility to another. However, consult the arrival facility’s policy to make sure. Also, the DNR may not be honored if you are discharged from the facility to your home if your state does not have an out-of-hospital DNR policy.

A DNR order may not be honored during surgery but this is something very important to discuss with your surgeon and anesthesiologist before surgery so your wishes are honored.

A DNR order should be posted in the home if that is where you are being cared for. If there is no DNR order, the healthcare team will respond to the emergency and perform CPR. The team will not have time to consult a living will, the family, the patient’s healthcare agent or the patient’s doctors if they are not present.

WHAT KIND OF MEDICAL CARE WOULD YOU WANT IF YOU WERE TO DEVELOP DEMENTIA?

Dementia is a common condition that generally affects people in their 70s and 80s. It is important to be able to tell caregivers what kind of care you would want to receive if you were to develop worsening dementia. The link below connects to the Dementia Directive website where they have a downloadable Advance Directive that can be used to detail what treatment the sufferer would want to receive in case of mild, moderate or severe dementia.

www.dementiadirective.org

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The Advance Directive PDF attachment below includes Thai translation and can be used both in Thailand and Internationally. The "What Makes Life Worth Living PDF attachment is a document to help facilitate discussion with family and friends regarding health care decisions at end of life.

© 2016 National Hospice and Palliative Care Organization
www.CaringInfo.org
CaringInfo@nhpco.org

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