How do I get a DNR/DNI?

Title. Jurisdiction is Pennsylvania, USA. Because I have very poor quality of life, I want to make sure I'm never resuscitated or intubated, no matter what. I got an advance directive that requests DNR/DNI/comfort care only, which should work in healthcare facilities. (Getting a DNR is wholly unrelated to self-harm and a common, legitimate medical decision enshrined the law of many countries and that many people with serious illness get.)

However, I want paperwork that's even stronger. I'm worried about medical emergencies outside a hospital, especially if I'm not at home. I don't think I can get an out-of-hospital DNR, but can I? Can I get a POLST form? And how?

There's a few scenarios I worry about:

• If I have a medical emergency at home, what documentation will stop the paramedics from attempting CPR? If I die, whom should my mom call instead of 911?
  
• Accidents are the leading cause of death in my age group. I'm particularly worried I could be involved in a car crash (also common), and EMS will give me care I don't consent to because they can't find my documentation.
• I exercise vigorously against medical advice. I'm worried I could have a cardiac arrest at a sports center and the same thing would happen.
• My doctor might refuse to give me a POLST form, unfairly, on the basis of my age, perceived level of physical health, or perceived mental health. This will cause me a lot of emotional distress.

 

I think you're getting at the core of my problem because I don't know if the solution is a lawyer or a doctor. Or a lawyer telling me what to say to a doctor. I don't think it would hurt to give my lawyer a call.

 

Do you happen to know any Jehova's Witnesses or someone with similar restrictions around medical stuff for religious reasons? If so, I think asking them for facts and advice could maybe be a good place to start? I know JW's have professionals in their organisation who are used to dealing with this kind of issues.

I have been looking into whether it's possible in my country to have a legal document drawn up to try and protect myself from involuntary and coersive BPS/psychiatric "treatment", to use for example if my severe ME for some reason would deteriorate so badly that I'd be completely unable to advocate for myself.

So far the best source of facts and information and templates for legal documents etc has been from friends who are JWs. Their instructions would obviously look very different from mine, but I think we can learn a lot from them and their experiences.

 

Lawyer, not doctor.

 

Sorry I do not know the ins and outs of USA medicolegal law but am well versed in Ao/NZ medicolegal law and think it is might be the same as I have found it has evolved from English law.

When you are unable to act for yourself, you can appoint another person to act on health related matters. In Ao/NZ this is called an enduring Power of Attorney for Health.

Usually it is a family member who you trust and respects your right to self determination and your advanced directive. The next option being a trusted friend. (Or a social/health NGO agency but that can be difficult if time passes and the named person leaves).

I would suggest you see a lawyer who will give you all the options.

I have been an enduring power of attorney for my father until his death and also an appointed guardian for some of my mental health clients acting out their advanced directives on health matters when they were too psychiatrically unwell to communicate their wishes.

In emergencies, it is difficult if the first responders to not resuscitate if they do not have your advanced directive in their health record system. In Ao/NZ, if you are known to the ambulance service, I think an advanced directive can be recorded if they are called out (say from a concerned neighbour etc or whatever critical event scenario). The paramedics need a legal out and if you have it recorded within their system via legal means, I think you will get your desired outcome of DNR.

 

Britain still has a similar thing. It's now called a Lasting PoA and it's been spilt into two types, finance and health.

My attorney is a sibling and I trust them implicitly, but I can't tell them to act against their own instincts. But then again, I haven't got a blanket aversion to resuscitation, it's only in some cases.

I think if I wanted a DNR in all situations I might ask someone outside the family, but it's still not an easy responsibility to ask someone to hold. I can think of a couple of people I'd do it for, though.

 

You might research POLST (Physician Orders for Life Sustaining Treatment) which is filled out by a healthcare professional.

Some quotes from the links below:

From the info below, it sounds like a person with a POLST would need to carry it with them in case of scenarios that happen outside a healthcare setting. Otherwise, first responders might not know the patient's wishes.

Here are some resources:
- https://capolst.org/wp-content/uploads/2014/08/2014POLST_FAQ_Consumers.pdf
- https://polst.org/wp-content/uploads/2022/03/2022.03.16-Who-Needs-a-POLST-Form.pdf
- https://polst.org/
- https://www.papolst.org/