It can be confusing to understand what each one of these documents do.  Each one covers a different question, and relying on only one, thinking it covers the others, can cause a problem. It is important to understand the purpose of each document:

What a DNR Does

A Do Not Resuscitate order is a medical order that tells emergency responders and hospital staff not to perform CPR or other resuscitation measures if your heart stops or you stop breathing. That is the entire scope of the document. It does not address chemotherapy, surgery, dialysis, antibiotics, feeding tubes, or where you receive care. It answers one question, and one question only: if your heart or breathing stops right now, should someone try to bring you back.

When it actually makes sense. A DNR makes sense for someone who is already very frail, of advanced age, or living with significant cognitive decline, when resuscitation is unlikely to restore any meaningful quality of life and may cause additional harm in the attempt.

It does not automatically make sense for someone who has a good quality of life today. Your baseline, not some imagined future decline, is what a DNR should be based on. If you are living well now, managing your health, engaged in your life, and something sudden happens, a medical event, an accident, an unexpected complication, most people in that position would want every reasonable chance to be revived and to return to the life they were living. A DNR would take that chance away, not because it reflects a decline that has already happened, but because the document was signed based on a fear of a decline that has not happened yet.

Signing a DNR should follow a conversation with your physician about your actual current health, not a general anxiety about becoming a burden or ending up in a vegetative state.

What a Health Care Proxy Does

A Health Care Proxy is a legal document in which you name an agent to make medical decisions on your behalf if you become unable to make them yourself. It does not take effect while you are capable of deciding things for yourself. It activates specifically when a physician determines you lack the capacity to make your own health care decisions.

Once it is in effect, your agent can:

• Consent to or refuse medical treatment on your behalf
• Choose which physicians and facilities provide your care
• Review your medical records
• Decide on the level of care you receive, including transfers between hospital, rehabilitation, and long-term care settings
• Make end-of-life decisions consistent with your wishes, if it comes to that

It does not give your agent authority over your finances or property. That is a separate document, a Durable Power of Attorney. It also does not override your own wishes while you remain capable of communicating.

This is the document that covers everything a DNR does not. If you have a medical event and are successfully resuscitated, or if you have a stroke, a serious infection, or any condition that leaves you unable to communicate, someone has to decide whether you go to a rehabilitation facility or a nursing home, whether you consent to a proposed treatment, whether you continue or stop a treatment that is not working. None of that is addressed by a DNR. Without a Health Care Proxy naming someone to answer those questions, the decision can default to a court-appointed guardian, someone who does not know you, rather than a person you choose.

What an Advance Directive Does

A Health Care Proxy answers who decides. It does not, by itself, answer how they should decide. That is the role of an Advance Directive, sometimes called a Living Will or a values statement.

An Advance Directive is not a set of medical orders the way a DNR is. It is guidance you leave for your health care agent, describing your overall wishes about end-of-life care and the quality of life that matters to you. It might address whether you would want life-sustaining treatment continued if there were little to no chance of recovery, how you weigh the possibility of extended life against the burdens of aggressive treatment, or what quality of life you consider acceptable versus not worth prolonging.

Your health care agent may need to make tough decisions often under pressure, sometimes without being able to ask you directly. An Advance Directive gives them guidance. Making a difficult decision about someone else’s life is hard. An advance directive can ease any doubt or questioning if they are making the right choice.

What You Should Have

At a minimum, you should have a Health Care Proxy.  An Advance Directive is a bonus, and a DNR only makes sense if you are already in poor shape. 

Having only a DNR leaves every other decision unanswered and for a healthy person is not appropriate.  Having only a Health Care Proxy leaves your agent guessing at your values in the hardest moments, unless you have already expressed your wishes to them.  Having only an Advance Directive, will result in the need for court involvement because it is not legally binding in exactly this kind of planning. If you are outside our service area, the NAELA directory can help you find an elder law attorney near you.any way and without a Health Care Proxy in place, no one has authority to make the decisions.

Understanding what each document is the first step in making sure you are prepared for your future.

If you are in the Greater Boston area and want help putting these documents in place, Senior Solutions Attorneys at Law works with solo seniors on