In this second episode of their comprehensive healthcare planning series, Absolute Trust Talk hosts Kirsten Howe and Ariana Flynn tackle the critical medical orders that work alongside your legal documents: DNR (Do Not Resuscitate) orders and POLST (Physician Orders for Life Sustaining Treatment) forms. Unlike the legal documents discussed in Part 1, these are doctors’ orders that emergency responders must follow—but only if they can see them. The attorneys reveal the shocking legal reality that paramedics are required to perform CPR on anyone they find unconscious unless they have a valid DNR order in hand. They explain why POLST forms are printed on hot pink paper (it’s a genius design for emergency visibility), where to keep these life-saving documents so they’re accessible when seconds count, and why you need both medical orders AND legal documents working together. This episode could save your life by ensuring your emergency medical wishes are honored when you can’t speak for yourself.
Time-stamped Show Notes:
0:00 Introduction
1:15 DNR (Do Not Resuscitate) explained – emergency medical protective orders for EMS
2:33 Who can sign DNR orders, and how they become part of your medical record
3:25 The paramedic dilemma – why emergency responders MUST perform CPR unless they see a DNR
4:28 The “lying on the sidewalk” scenario that reveals the shocking legal requirement
5:00 Why your DNR needs to be accessible – it’s not tattooed on your forehead
5:45 Where to get DNR forms and the California Medical Association resource
5:58 POLST forms explained – going beyond DNR with comprehensive medical orders
8:21 Real-world POLST placement in assisted living and skilled nursing facilities
8:54 Why these are doctors’ orders, not legal documents, attorneys can prepare
9:15 The essential combination – why you need DNR, POLST, AND healthcare directives working together
Transcript:
Hello and welcome to Absolute Trust Talk. I’m Kirsten Howe, the managing attorney at Absolute Trust Council, and here with me is Ariana Flynn, one of our associate attorneys. You may notice that our hair and our clothing are the same as they were in the last episode because we’re recording these back to back.
If you recall from our last episode, we were talking about healthcare planning and end-of-life planning, and we talked about two legal documents that we include in our estate plans. Today we’re going to continue that conversation, but we’re going to be talking about medical documents. These are doctors’ orders that clients—in our case, clients; in the doctor’s case, patients—prepare together with their doctor to address some of their treatment and end-of-life concerns. And again, there are two of them that we’re going to talk about. We get a lot of questions about these in our estate planning, but they are not legal documents, so we can’t prepare them for our clients. All we can do is talk to them and educate them about them, and that’s what we’re doing here today. Ariana, do you want to talk about the first one?
“Yes, absolutely. So the first one is the DNR document, and that stands for ‘do not resuscitate.’ This is an emergency medical protective order that the EMS, or emergency medical services, are pretty accustomed to. They are able to understand what that document is, and the purpose of it is to instruct the EMS, the emergency team, or—if you’re at the hospital—the emergency response team there about your preferences regarding any life-sustaining emergency treatment. So things like CPR, chest compressions, assisted ventilation, intubation, defibrillation—those things to get the heart going again when it stops. So these are more immediate emergency interventions, rather than compared to the advance healthcare directive, where those are more life-sustaining over a longer-term period of time and not so much emergency-in-the-moment type of treatments. So that’s kind of how those two differ.
The DNR obviously has to be signed by the patient themselves or their healthcare decision-maker at the time, and then also by their physician. So their doctor becomes a part of the patient’s medical record. So the hospitals should have that DNR if they transfer hospitals—it should be transferred as well. And it doesn’t mean that they can’t receive any type of treatment. It is a preference on which treatments they do and do not want.
Again, these are revocable documents, so the patient could revoke that document at any time or change it at any time if they so want to. And it is one of those documents that is accessible by the staff, so it should be visible and present in front of the medical staff at all times, especially if they are in a situation where emergency services are more likely to be provided.”
“Yeah, and that is maybe one of the most important points about it. If you are someone who, for whatever medical reason, has decided that you want a DNR—if you’ve decided that you want a ‘do not resuscitate’ order entered into your medical record, maybe because you’re elderly and fragile, or you’ve got some long-term chronic illness, or even a terminal illness—this order basically works by saying, ‘If you ever find me lying on the sidewalk and I’m not breathing, my heart’s not going, don’t administer CPR. I don’t want chest compressions. I don’t want the paddles,’ whatever you want to say. But this is a doctor’s order; therefore, the emergency team can follow it and they’re not going to get in trouble. In other words, it’s basically saying, ‘I’m taking responsibility. I don’t want CPR. You are off the hook,’ because if a paramedic rolls up to somebody lying on the sidewalk, they have to start chest compressions. That’s what they have to do. That’s their job. But if you have this, they don’t, and they won’t. But unless they see that order, they will, because that’s their job—that’s what they’re legally required to do.
So Ariana’s point about it needing to be available—it needs to be nearby—is a very important one. It would be in your permanent record, but your permanent record is at Kaiser or at your clinic. It’s not on your forehead. It’s not tattooed on you. So a lot of people will keep this on the refrigerator or someplace handy if they’re at home so they can grab it and show it to the paramedics when they arrive. And I suppose you could carry it around with you or have whoever you travel around with carry it, but it’s only effective if the emergency personnel are aware of it—I guess that’s my point.
And you can get these—the California Medical Association has these forms on their website. You can access them and fill them out with your doctor. It has to be signed by a doctor to be valid.”
“Okay, so let’s talk about the next one. Ariana, do you want to get started on that one?”
“Yes, absolutely. So the next one is kind of an expansion of the DNR. So it goes beyond the DNR with more interventions. And it’s the POLST form—that stands for Physician Orders for Life-Sustaining Treatment. And this is a medical order that gives really ill patients the ability to choose specific types of interventions that go beyond just that end-of-life emergency-type service intervention at that moment. So things like intubation, nutrition, artificial hydration that are more life-sustaining over a longer period of time, rather than the emergency interventions. Again, the POLST is typically for really ill or very fragile or elderly patients, and again, the POLST has to be signed by the physician, nurse practitioner, or physician assistant, as well as the person with the ability to make those decisions—the patient or the healthcare decision-maker at the time.”
“Yeah, it’s like a DNR, but the DNR is very narrow. It’s just ‘don’t resuscitate me.’ That’s the only issue in the DNR. In the POLST, you can say anything that you and your doctor want to say. You can say anything, and it becomes a doctor’s order, such that if your doctor is not in the room and you are unconscious, people know what they’re supposed to do. It’s a doctor’s order.
The POLST is much more common with our elderly clients. A lot of our elderly clients have POLSTs, and it’s a hot pink form. If you’ve ever seen it, you’ll remember it. It’s printed on hot pink paper for a reason, because it’s got to be something that people will look at. They’re going to find it easily. And again, I think my clients put them on the refrigerator, and if emergency personnel ever show up, they show it to them, or you can grab it and bring it to the hospital. I know a lot of people in assisted living facilities and skilled nursing have POLSTs, and they have them right there by the bed.”
“Right. Okay, so these are two things that may be more specific to people with particular health concerns. They are doctors’ orders. We, as lawyers, can’t help you with them, except we can educate you about them, and that’s the goal here today. Ariana, anything else that we need to add about either of these?”
“Yeah, just one additional comment: these go hand in hand with each other. You don’t just want the DNR, the POLST, or the advance healthcare directive. You want a combination of all of them if they apply to you, because the healthcare directive—the advance healthcare directive—is a legal document that appoints the agent. POLST and DNR are a little bit more specific on the therapies and interventions, specifically to the emergency medical services and to the physician too. So they all go hand in hand and do work together.”
“Yeah, that’s an excellent point. Just because you have a POLST doesn’t mean you don’t need a healthcare directive. If you didn’t hear me in the last episode, I said it: everybody needs a healthcare directive if you’re 18 or older. Okay, very good. Thank you, Ariana, and we are going to do one more episode on this topic. We’re going to get into the more heavy stuff—the assisted suicide and euthanasia—in the next episode. So come on back, and we hope you learned something today, and we look forward to connecting with you next time.”
Resources Related to This Episode:
- Absolute Trust Talk Episode 189: Your Healthcare Voice: Understanding Advanced Directives https://absolutetrustcounsel.com/189-your-healthcare-voice-understanding-advanced-directives/
- Absolute Trust Talk Episode 125: Cher Files for Conservatorship of Son Elija Blue Allman https://absolutetrustcounsel.com/125-cher-files-for-conservatorship-of-son-elijah-blue-allman-over-alleged-substance-abuse/
- Absolute Trust Talk Episode 124: Beach Boys Founder Brian Wilson Suffering from Dementia as Rep Seeks Conservatorship https://absolutetrustcounsel.com/124-beach-boys-founder-brian-wilson-suffering-from-dementia-as-reps-seek-conservatorship/
- Absolute Trust Talk Episode 113: How to Avoid a Chaotic “Casey Kasem” Estate Plan https://absolutetrustcounsel.com/113-how-to-avoid-a-chaotic-casey-kasem-estate-plan/
- Blog: Estate Planning for College Students https://absolutetrustcounsel.com/estate-planning-for-college-students/
- Blog: Summer’s Here, It’s Time to Open Up (to Your Estate Planning Attorney) https://absolutetrustcounsel.com/summers-here-its-time-to-open-up-to-your-estate-planning-attorney/
- A Will is Not Enough – Securing Your Legacy with Estate Planning Life can change in an instant. A will is not enough to be prepared. Get free access to our actionable E-book Guidebook #1 and start protecting your legacy today. https://absolutetrustcounsel.com/guidebooks/
- Learn how to comfortably define gray areas and assess your unique needs to build a secure future now effortlessly. Check out Guidebook #2, Estate Planning Beyond the Basics, here > https://absolutetrustcounsel.com/guidebooks/
- Get our free introductory guide to the most used estate planning tool, family trusts, and understand how we plan to help protect your family. Guidebook #3: https://absolutetrustcounsel.com/guidebooks/
- Absolute Trust Counsel would love to offer access to our Incapacity Planning resource page: https://AbsoluteTrustCounsel.com/Incapacity-Planning/. We’ve collected our top planning information all in one place so listeners can find videos, guidebooks, blog posts, and a host of information with tips and strategies on implementing, planning, and protecting themselves and their loved ones.
- We’re pleased to provide a library of e-books to address common estate planning questions and concerns in practical, easy-to-understand language. https://AbsoluteTrustCounsel.com/Resources/.
- ASK KIRSTEN: If you’d like Kirsten to answer your question on the air, please email her at Info@AbsoluteTrustCounsel.com.
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