CPR is a medical intervention. A competent patient may refuse to have CPR performed in the event of a sudden death; this is known as a Do Not Resuscitate Order (DNR).

There is a newer form of an advanced directive that memorializes the wishes of a competent patient. Called the “Physicians Order for the Life Sustaining Treatment”, it is portable, brightly colored, and addresses not only CPR, but also antibiotic use, artificial nutrition, and degree of medical intervention desired. The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes.

The purpose of this paradigm is to convert the patient’s treatment goals into medical orders. The process is based on communication with patients and/or surrogates (i.e. an informed consent process). It is not just a form, but a program that brings together multiple providers from across the healthcare system to meet the goals of patients. In order to be considered a POLST Paradigm Program, the Program must include these elements:
1. The form constitutes a set of medical orders.
2. The process includes training of health care providers across the continuum of care about the goals of the program as well as the creation and use of the form.
3. Use of the form is recommended for persons who have advanced chronic progressive illness, those who might die in the next year or anyone wishing to further define their preferences of care.

The form may be used either to limit medical interventions or to clarify a request for all medically indicated treatments including resuscitation. The form provides explicit direction about resuscitation status if the patient is pulseless and apneic. The form also includes directions about other types of intervention that the patient may or may not want, for example, decisions about transport, ICU care, antibiotics, artificial nutrition, etc. The form accompanies the patient and is transferable and applicable across care settings (i.e. long term care, EMS, hospital). The form is uniquely identifiable, standardized, uniform color within a state/region. There is a plan for ongoing monitoring of the program and its implementation.

“If dying patients want to retain some control over their dying process they must get out of the hospital they are in, and stay out of the hospital if they are out.” George Annas, Bioethicist

Common causes of action for non-implementation of advance directives include medical battery, breach of contract, negligence, lack of informed consent, wrongful life or prolongation of life, and intentional infliction of emotional, physical, and or financial distress.

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