The Difference Between Living Wills, POLST Forms, DNR, DNI and DNH Orders
Many people are confused about the use of Advanced Directive and Health Care Proxy (Living Will), Physician Order Life Sustaining Treatment (POLST) and Do Not Resuscitate (DNR), Do Not Intubate (DNI) and Do not Hospitalize (DNH) forms.
A Living Will is a document prepared with the assistance of an attorney. This document states in advance your wishes about life-sustaining treatment when you are terminally ill, permanently unconscious or in the latter stages of a fatal illness. It also selects who you want to speak on your behalf.
Physician Order Life Sustaining Treatment
Physician Order Life Sustaining Treatment (POLST) is fairly new to the State of New Jersey. This document deals with persons who have end of life illnesses and what efforts are to be undertaken. This document is signed by both the patient and/or his/her representative and the treating doctor.
Do Not Resuscitate
Do Not Resuscitate (DNR), Do Not Intubate (DNI) and Do not Hospitalize (DNH) are physician signed orders. They do not require the patient's signature.
A DNR is a physician's order for a patient indicating that no basic or advanced Cardiac Life Support efforts (ie no chest compressions) will be initiated in the event of cardiac and/or respiratory arrest. This is typically done in a hospital or nursing home facility by the doctor, after consultation with the patient and/or his/her family. This order may be revoked at any time by the patient or another in his/her presence at his/her direction by the cancellation or destruction of the DNR Form or, by an oral expression by the patient or surrogate decision maker of the intent to revoke.
Do Not Intubate
A DNI order means that while the physicians may use chest compressions and cardiac drugs, no breathing tube will be placed in the patient. The DNI is distinct from a DNR. The two are separate because you can have trouble breathing before your heartbeat or breathing stops. If your breathing problems continue, your heart or lungs may go into full arrest. Intubation, however, may avert cardiac or respiratory arrest.
Do Not Hospitalize
For DNH, a trip to the hospital can cause complications for seniors with advanced dementia or any other individual suffering from a major illness. The alternative is to treat them and/or offer comfort care at home or in the long-term care facility where they are currently residing. The purpose of the DNH is to allow nature to take its course, with appropriate palliative care, rather than to subject the individual to hospitalization.