DNR/DNI/HCD/POLST:  What do I need?

In Minnesota, a Health Care Directive (HCD) is the legal document in which a person, age 18 or older, can appoint an Agent or proxy to make medical decisions in the event the person is unable to communicate their wishes.  When someone is terminally ill you may hear the acronyms like DNR, DNI, POLST, and HCD used by the professionals surrounding the ill person and confusion can arise from all the acronyms.

Health Care Directives (HCD) are important for every adult to appoint a person trusted to follow through with the wishes of the document maker.  HCD can reduce family conflict in having a key decision maker appointed and clear instructions as to the medical wishes of the person who made the HCD.  A healthcare directive encourages open communication between individuals, their loved ones, and healthcare providers. It prompts important conversations about values, goals of care, and end-of-life wishes, fostering understanding and support among all parties involved.  Most importantly, a healthcare directive is important because it allows individuals to maintain control over their medical care, express their wishes clearly, and ensure that their values and preferences are respected, even when they are unable to communicate those wishes for themselves. It provides peace of mind for individuals and their loved ones knowing what levels of care are desired, promoting dignity and autonomy in decision-making.  Health Care Directives are often completed with an estate planning attorney; it is recommended that clients give a copy of their HCD to their medical provider.

Do Not Resuscitate (DNR) is a medical directive that instructs healthcare providers not to attempt cardiopulmonary resuscitation (CPR) if an individual’s heart stops beating, or if they stop breathing.  A DNR order specifically pertains to CPR and does not affect other medical treatments or interventions. It is focused solely on resuscitation efforts in the event of cardiac or respiratory arrest.  DNR orders are often used in situations where individuals have serious or terminal illnesses, advanced age, or significant medical comorbidities. DNR orders are typically documented in the individual’s medical record, and often involve the completion of specific forms or paperwork.

Do Not Intubate (DNI) is a medical directive like a DNR (Do Not Resuscitate) order but a DNI specifically pertains to intubation, which is the insertion of a tube into the airway to assist with breathing.  A DNI order instructs healthcare providers not to perform endotracheal intubation or provide mechanical ventilation to assist with breathing in the event of respiratory failure or arrest.  Similar to DNR orders, the decision to implement a DNI order is typically made by the individual, in consultation with their healthcare provider.  DNI orders specifically address intubation and mechanical ventilation and do not affect other aspects of medical treatment.  Like DNR orders, DNI orders are documented in the individual’s medical record and may involve the completion of specific forms or paperwork. This documentation ensures that healthcare providers are aware of the individual’s preferences regarding intubation and ventilation.

Providers/Physicians Orders for Life Sustaining Treatment (POLST) is a medical order that outlines a patient’s preferences regarding specific life-sustaining treatments. POLST forms are typically used for individuals with serious illnesses or advanced frailty who may be nearing the end of life.  POLST forms can include provide specific medical orders regarding resuscitation, intubation, medical interventions, and end-of-life care based on the patient’s preferences. A POLST is intended to guide healthcare providers in emergency situations to ensure that the patient’s wishes are honored.  The decision to complete a POLST form involves discussions between the patient (or their authorized decision-maker) and their healthcare provider. It is based on the patient’s current medical condition, prognosis, and treatment goals.

The benefits of creating medical directives, such as a Health Care Directive for anyone over age 18, DNR/DNI orders and POLST forms where applicable, cannot be overstated. These documents serve as invaluable tools in ensuring that people receive medical care that aligns with their preferences, values, and goals, particularly in situations where they are unable to communicate their wishes directly.  Moreover, these documents, once executed, promote autonomy and dignity by allowing individuals to direct their healthcare decisions, even in times of incapacity. They offer peace of mind, knowing that their wishes will be respected and will hopefully minimize any conflict among family and friends making the decisions.  Overall, the process of creating a health care directive is an essential part of estate planning. When applicable an estate planner will encourage you to discuss if a POLST/DNR/DNI with your medical provider to make sure you have a comprehensive medical directive plan.