Advance Directives, Part Two: The EMS Perspective
This is part two of a three-part series on the legal instrument called an Advance Directive. You may have heard of the Advanced Directive by other names, like "DNR" (Do Not Resuscitate order), or "Living Will", but they're all essentially the same instrument, and that's what we're talking about here. You can find the first part here, and the third part here.
The first post in this series talked about why you should have an Advance Directive. This one talks about the other side of the Advance Directive: the EMTs and paramedics who respond to a 911 call.Understanding EMS Priorities Versus Your Priorities
In EMS, we have a fairly simple mandate: keep you alive, and get your rear end into a hospital, preferably a big, well-equipped one. Your wishes, in terms of what you might or might not want "done" to you, don't enter into the equation unless those wishes are explicitly enumerated in a (legally binding) Advance Directive. Unless we have something in writing (witnessed and notarized) that tells us otherwise, we assume you want us to move heaven and earth to save you.The Dark Side Of Saving Your Life
As I was saying, unless you have a properly witnessed and notarized Advance Directive (not a copy) at your bedside or on your person, we're going to do everything we can to save you. More importantly, we are legally bound to do so: that means taking the stereotypical heroic measures. "Heroic measures", in this context, tends to mean:
Why? Because we're legally bound to do so. Under the law, we must take all actions available to us unless a legally binding Advance Directive specifies otherwise. If we don't do everything within our powers, we can (and will) be brought up on charges, including abandonment and professional negligence.Why Can't My Family Tell You Not To Do These Things?
Well, your family can tell us not to do these things. They can also tell us that you don't wish them to be done. They can tell us just about anything.
Unfortunately, we're not going to listen to your family: we can't. Without proof of your wishes, in the form of an Advance Directive, we're legally bound to act as if you wanted all lifesaving measures to be taken. That's the law, and it's notoriously inflexible on this particular point.
Also, that inflexibility makes a lot of sense. Would you want us taking someone's word for it? Especially if it was in that person's financial interest for you to die? It's not unheard of for people with a fiduciary interest in someone's death to, shall we say, elide the truth. And, no matter how much you trust the people around you, with something of this magnitude there's no downside to drawing up a legal document. Everyone wins: you get insurance that your wishes are followed, and they don't have to make potentially catastrophic decisions.
Fundamentally, if you're incapacitated, your Advance Directive is the only legally guaranteed and viable method you have of "speaking for yourself". It, and not your family, is the only legally accepted final arbiter of the measures EMS personnel will or won't take to preserve your life.Where To Keep It
If you're going to do one Advance Directive, you should do two. And if you're going to do two, hell, make three. Seriously. There's a simple reason for this: you want the Advance Directive physically present with you.
I recommend getting valid Advance Directives made up in a wallet size and carrying one with you at all times, as well as having a valid Advance Directive both in a safe place (like, for instance, at your attorney's office) and in an easily located place next to your bed, very clearly marked.
The reason for all this precaution? An Advance Directive doesn't do you any good if it can't be found. It doesn't matter if you've got one under the bed, and it just can't be found at the moment. Our work is time-critical, and unless you're waving a legal Advance Directive in our faces, we're going to be going all-out to salvage as much of the Golden Hour as we can. Next: State By State
In the final installment of this series, you'll find links to each state's Advance Directive laws.
