DNR Formats

Advance directives should be reviewed and revised whenever major changes occur in someone’s life or healthcare preferences. A general recommendation is to review these documents at least once a year, but suggestions vary. For example, the nonprofit Compassion & Choices recommends that people review their directive whenever one of the “5 Ds” occurs:

• Death of a loved one
• Divorce of major family change
• Diagnosis of serious health condition
• Decline or change in health
• Decade has passed

Sometimes, an individual must update a directive based on who is designated as the healthcare agent. For example, a named agent may be diagnosed with a serious medical problem, or their health may begin to decline. In that case, updating the directive to name another agent is highly encouraged. Another example is if the designated agent is a former spouse after a divorce. Some people may not be comfortable maintaining their former spouse as an agent and would need to update their directive with new forms after the divorce is final. 

 A death in the family can be another cue to update an advance directive. Since deaths can affect the family structure and support system, some family members may become limited in their ability to serve as a named agent if the recent death has resulted in increased responsibilities. Similarly, if the designated agent dies, the documents will need to be updated to appoint a new agent. Otherwise, there will be no one to act on behalf of the patient when the advance directive goes into effect.

Moving to a new location is another significant change that often requires an update to advance directives. States often have specific requirements regarding the information that advance directives must contain to be legally valid. While some states may honor the current version of the advance directive from the previous state, the best practice is to confirm validity and make any necessary updates.

Sources

“Advance Care Planning: Advance Directives for Health Care”. National Institute on Aging. https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care

Compassion & Choices. https://compassionandchoices.org/ 

“How to Revise Your Estate Plan After a Divorce”. DivorceNet. https://www.divorcenet.com/resources/how-to-revise-your-estate-plan-after-a-divorce.html 

“How Often Should You Update Your Documents?” Hurley Elder Care Law. https://hurleyeclaw.com/how-often-should-you-update-your-documents/ 

“Keep your health care directives up to date”. Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/keep-your-health-care-directives-up-to-date 

Yes, individuals can change or revoke their advance directives at any time as long as they are capable of making their own decisions. Advance directives are intended to be living documents that are updated as needed based on the values and goals of the individual. If there are changes in treatment preferences, their health status, or if they have experienced a major life event, individuals are encouraged to update their advance directives to reflect those changes. 

In fact, it is highly recommended to review advance directives regularly and update as often as needed. 

Any changes that are made to an advance directive should be shared with family, loved ones, the health care agent, and the relevant care team to ensure they are aware of the updates. Although advance directives can be changed at any time, there are instances when revoking an advance directive may be more convenient. Potential scenarios where revoking an advance directive is more appropriate than updating it can include: 

• Naming a new agent responsible for making decisions, ensuring that it is clear who has the newly appointed authority
• When beliefs and values have changed significantly and updating is more time-consuming compared to establishing a new advance directive
• When the previous advance directive has too many unclear instructions and creates too much ambiguity regarding the actions that need to be taken 

While oral revocations of advance directives can be acceptable, it is highly encouraged to have written documentation of the revocation and to destroy former documents that are no longer applicable. This helps to establish more clarity regarding which documents are current. Finally, although advance directives can be established without hiring an attorney, it is advisable to seek professional guidance when determining whether an advance directive should be revoked or updated to reflect recent preferences and values. 

Sources

“Frequently Asked Questions About Advance Directives”. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/making-treatment-decisions/advance-directives/faqs.html 

“Revoking Your Health Care Directive”. Quicken WillMaker. https://www.willmaker.com/legal-manual/health-care-directives/revoking-your-health-care-directive.html

After completing your advance directive, make copies and give one to everyone who is close to you, including your spouse/partner, children, siblings and all those who are important in your life.  Sit down with them at a convenient time, go over your wishes and talk about why you have made the decisions you’ve made. Even if your family doesn’t agree with your point of view, they will appreciate your taking the time to explain it to them. You should also give a copy to your attorney, your health care team and your health care proxy, and, of course, keep a copy for yourself. 

After giving copies to the important people in your life, store the original document in a secure and easily accessible place, such as an unlocked desk drawer or even in the refrigerator, where it will be protected in the event of fire or flood. It’s also more likely to be found there by emergency services personnel while they are looking for medications or a medication list. Make sure your health care surrogate and others in your family know where it’s kept and that the location is accessible to them. Emergency personnel are trained to look in certain places, including the refrigerator door, the door to a bedroom or the back of the front door, so consider leaving a copy in those locations. 

Another option for storing your advance directive is to contract with a service that will store it in the cloud and make it available to your health care provider on your behalf. For an annual fee, MedicAlert will store a copy of your advance directive and prehospital DNR form as part of your emergency health record. It will also provide a MedicAlert bracelet bearing the words “Do Not Resuscitate” for you to wear if that’s your wish. 

The U.S. Advance Care Plan Registry provides a similar service and makes all of your advance planning documents (including a POLST or out-of-hospital DNR) available to EMS and medical providers via the internet or a mobile app. There are also a growing number of apps and services that allow a person to create and save a digital advance directive and video sharing their wishes. 

Sources

“My MedicAlert Services”. MedicAlert. https://www.medicalert.org/medical-id-services/my-medicalert-services 

U.S. Advance Care Plan Registry. https://www.usacpr.com/ 
“About Digital and Video Advance Directives”. CaringInfo. https://www.caringinfo.org/planning/advance-directives/digital-video-advance-directives/