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ADVANCED DIRECTIVES AND END OF LIFE

Category: EMS Operations

Topic: Medical/Legal and Ethics

Level: EMR

Next Unit: Confidentiality

3 minute read

ADVANCED DIRECTIVES: defined as a written statement of a person’s wishes regarding medical treatment. Often including a living will, these statements are made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

Do Not Attempt Resuscitation (DNR) Order: a type of advanced directive that is usually present when a patient has a terminal disease that is associated with medical futility.

DNR’s are hospital, EMS, and facility specific. 

It is an order written by a doctor, has a time limit, and does not eliminate non-resuscitative treatment.

MEDICAL FUTILITY: interventions that are unlikely to produce any significant benefit for the patient and which are categorized into two distinguishable categories:

  1. QUANTITATIVE FUTILITY: where the likelihood that an intervention benefitting the patient is extremely poor. 
  2. QUALITATIVE FUTILITY: the quality of benefit that an intervention will produce is extremely poor.

Quantitative = benefit of intervention.
Qualitative = the quality of benefit an intervention will produce.

LIVING WILL: a type of advanced directive indicating a patient’s wishes that may not address the emergency medical response in your state.

Surrogate decision-makers have durable power of attorney for health care and follow a healthcare proxy or legal document wherein a patient appoints an agent to legally make healthcare decisions on behalf of him/her for when he or she is incapable of doing so. Oftentimes the next of kin is the surrogate decision maker.