In California, planning for future medical care often involves two critical documents: the Do Not Resuscitate (DNR) order and the Advanced Health Care Directive (AHCD). While both relate to decisions made for end-of-life care, they serve different purposes and are governed by distinct legal statutes.

A DNR order is a specific medical order that tells medical staff not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the heart stops beating. The California Health and Safety Code Sections 7185 to 7195 provide the legal framework for DNR orders, ensuring that individuals' wishes regarding resuscitative efforts are respected. For example, consider Jane Doe, an 80-year-old with terminal cancer, who opts for a DNR because she wants to pass naturally without aggressive life-saving interventions. Her physician signs the DNR order, making it a part of her medical record, ensuring that in the event of cardiac or respiratory arrest, CPR will not be administered.

On the other hand, the AHCD is a broader document that allows individuals to outline their healthcare preferences, appoint a healthcare agent, and provide guidance for future health care decisions if they become unable to speak for themselves. Governed by the California Probate Code Sections 4600-4806, the AHCD encompasses decisions beyond just resuscitative efforts. For instance, John Smith, a 50-year-old with a chronic illness, might use an AHCD to specify not only his DNR wishes but also his preferences for other treatments like ventilation or tube feeding. He can appoint his sister as his healthcare agent, entrusting her to make decisions aligned with his values and instructions in the directive.

The difference between these two documents was highlighted in the notable case of In re Conservatorship of Wendland (2001), where the California Supreme Court addressed the issue of withdrawing life support from a conservatee without clear evidence of the patient's wishes. This case underscores the importance of having an AHCD to clearly document one's healthcare preferences and avoid legal disputes.

To avoid the perils of misunderstandings and ensure that your healthcare wishes are respected, it's crucial to take the following steps:

1. Execute both a DNR and AHCD: Have a clear and legally compliant DNR order if you wish to forego resuscitative efforts and complement it with an AHCD to cover broader healthcare directives.

2. Consult with healthcare professionals: Ensure that your DNR order aligns with your health status and that your AHCD clearly states your healthcare preferences.

3. Communicate with loved ones and healthcare agents: Discuss your decisions with family members and your appointed agent to ensure they understand and respect your wishes.
4. Review and update regularly: Healthcare preferences may change over time, so regularly review and update your documents to reflect your current wishes.

In California, a DNR order typically requires the signature of a physician to be valid, as it is a medical order that must be followed by healthcare providers. The physician's signature confirms that the patient has made an informed decision to forego resuscitative efforts, and that this decision aligns with their current medical condition and overall health care goals.

However, an Advanced Health Care Directive (AHCD), which may include preferences about resuscitation (such as DNR instructions), can be executed by the patient alone without the need for a physician's signature. The AHCD must be signed by the patient (or their representative) and either witnessed by two adults or notarized.

Here's how these two elements typically work:

·         DNR Order: Requires a physician's signature to be legally valid. The purpose of the physician's signature is to confirm that the patient has been informed about the implications of a DNR order and that it is medically appropriate.

·         Advanced Health Care Directive (AHCD): The patient can complete this document independently, but it needs to be either notarized or signed by two adult witnesses who are not healthcare providers at the patient's current treatment facility, not related by blood, marriage, or adoption, and not named as beneficiaries in the patient's estate.

For a DNR to be actionable, especially in emergency situations, healthcare providers look for a physician-signed DNR order. However, if a patient has specified their wishes regarding resuscitation in an AHCD, those wishes should be respected as part of honoring their broader healthcare preferences, though in practice, the presence of a physician-signed DNR order can facilitate immediate recognition and compliance by emergency personnel and healthcare providers.

To ensure that a DNR preference is respected, especially in emergency situations, it is crucial to have both an AHCD outlining the individual's wishes and a physician-signed DNR order that can be easily accessed and verified by healthcare professionals.

Navigating the complexities of end-of-life legal documents can be challenging. At the Law Office of James Burns, we specialize in guiding clients through the intricacies of estate planning and healthcare directives. With expertise in California's legal landscape, we can help you create a comprehensive plan that ensures your healthcare wishes are clearly documented and respected.

To secure your future and ensure your wishes are honored, contact the Law Office of James Burns at (949) 305-8642 or visit www.jamesburnslaw.com. Let us help you with your estate planning needs, ensuring peace of mind for you and your loved ones.