Advance Directives
Autonomy – The right to make independent choices
and decisions – based on values and experiences.
Advance directives – insure that personal
preferences are met if decision making ability is
impaired either by a sudden illness or a long term
illness.
Cardiopulmonary resuscitation (CPR) - hand
compressions and rescue breathing designed to
maintain blood flow to the brain. In the healthcare
setting this can include artificial means of breathing.
Artificial breathing – requires a tube placed in the
airway. This can be:
 Refused
 Temporary
 In some disease processes it can be long term.
Do not resuscitate (DNR) – An order not to initiate
CPR and allow natural death.
***Even though an individual chooses not to be
resuscitated, that doesn’t mean that all medical
treatment will be withheld. Because of that,
additional directives are helpful in assuring that
your wishes are followed.
Comfort cares only – Many individuals only want
treatments directed at maintaining comfort. This
would include medications, oxygen, clearing of
airways. If cardiac arrest or life threatening illness
occurs at home, 911 would not be called and there
would be no transfer to the hospital for more life
sustaining treatment. If it occurs in the hospital,
only comfort measures would be provided.
Life sustaining treatment – Everything possible is
done to maintain life. That can include invasive
diagnostic testing, surgery, intravenous
medications, or long periods of hospitalization.
Diagnostic Testing – Blood tests and procedures are
used to identify the cause and potential treatment
options for an illness. If the goal is comfort, the
discomfort of testing would, in most cases, be
greater than any benefit.
Antibiotics – Serious infections can lead to death,
particularly in the very young and older individuals.
Choices for antibiotic therapy include:
 No antibiotics – Individuals can survive
without antibiotics, however using them, if
indicated, can prolong life in some situations.
 Oral antibiotics – Can be effective in treating
infections if the individual is able to swallow.
 All antibiotics including intravenous (IV) and
intramuscular (shots) – These include some
discomfort including blood tests.
Nutrition and hydration –
 Food and liquids can be offered by mouth
which allows the individual to maintain
quality of life. If an individual is unable to
swallow or refuses to swallow, dehydration
will lead to death within days to weeks. We
can survive without food for several months.
 Tube feedings through the nose or mouth are
used on a temporary basis when someone is
ill to maintain nutrition for healing, for
example after surgery.
 Tube feedings placed directly into the
digestive tract are designed for long term
nutritional support. There are many studies
that have found no benefit of tube feedings in
individuals with dementia.
 IV fluids – Used on a temporary basis to
maintain hydration. These are actually a
discomfort at end of life due to needle sticks
and difficulty for the body to manage extra
fluids as organs begin to “shut down”
For more information, please call Essentia Health St. Mary’s Oak Crossing Social Services, 218-844-0719 or 218-844-8376