Question: The last time I was in the hospital I signed a DNR. Do I still need a health care proxy and living will?

Answer: The short answer is yes. A “DNR” is a do no resuscitate order. This is a document that a patient requests from a doctor. The DNR states that a patient should not be revived if they stop breathing or the heart has stopped; it does not refer to any other type of medical interventions. With the signing of a DNR, the patient is expressing their wishes not to have mouth-to-mouth, chest compressions, electric shock, medicines to get the heart pumping, or a tube to assist breathing. The DNR is signed with two witnesses, one of which is a physician. When you leave and re-enter the hospital, it is often necessary to sign a new DNR.

While the DNR is usually signed while an individual is a patient in a hospital, some documents can be signed in advance to let the person’s wishes be known about all types of medical intervention. Signing these documents in advance makes it clear who will be making decisions for you and gives direction to that person so they can follow your wishes regarding treatment.

The document that states who will act on your behalf if you cannot act for yourself is a health care proxy. This is signed by you in the presence of two witnesses. Unlike the DNR, there is no requirement that one of the witnesses be a doctor. Only one agent can act on your behalf, but you can designate successor agents who will act if the first person named becomes unavailable or unwilling to act. It is very important that your health care proxy states that your agent knows your wishes with regard to artificial nutrition and hydration so that they may make decisions about those kinds of treatments and other end of life decisions. If you are unable to sign a DNR, the agent named in the health care proxy can sign it for you.

In addition to a health care proxy, you can sign a living will so that your wishes regarding end of life treatment will be known. Like the health care proxy, the living will requires two witnesses, but there is no requirement that one be a doctor. The living will states your wishes regarding the administration or withholding of treatments if you were in an incurable state with no reasonable expectation of recovery. The living will gives examples of the types of treatments that you would not want administered if you were in this state; this includes cardiac resuscitation, but goes further to discuss other types of treatments as well.

Many people know the term “DNR”, but do not realize that it is only talking about interventions when you have stopped breathing or your heart has stopped. The limited nature of the DNR makes it very important to sign a health care proxy and a living will in advance so that your wishes can be known and your care can be entrusted to the person you choose to act on your behalf.