The Use of Advanced Directives and Do Not Resuscitate Orders
Please review our policies below before completing the following:
Kenwood Animal Hospital Policy Pertaining to the Use of Advanced Directives and Do Not Resuscitate Orders (DNRs)
Kenwood Animal Hospital has adopted the following policy pertaining to the use of advance directives and DNRs, to ensure that the medical decisions made on behalf of our clients’ pets reflect owners’ wishes which have been clearly communicated to the hospital staff. Such directives shall be used only after clients have been fully informed of the medical condition of their pets and consequences of their decisions. These decisions should reflect a clear commitment to serve the needs and best interests of the patients and be made only after careful consideration by clients and attending veterinarians. The following guidelines have been developed to provide pet owners, veterinarians, and hospital staff with support and guidance in making decisions to withhold or withdraw life-sustaining treatments from our patients.
• Advanced directives are documents by which clients provide instructions to their veterinarians as to the type and extent of health care that should be provided to their pet if they are not available to make decisions at the time such choices are medically required. Advanced Directives guide veterinarians as to what types, if any, of life sustaining treatments should be provided to terminally or critically ill pets.
• Medical powers of attorney permits clients to appoint persons to make medical treatment decisions for their pets. If an Advanced Directive has been completed for a pet, the appointee’s decisions would be guided by that document.
• A DNR is provided by the veterinarian and requires the client’s consent and signature. It serves to notify all attending medical personnel that no one is to use cardiopulmonary resuscitation to revive a patient if the pet stops breathing or experiences cardiac arrest.
• For pets that are admitted as critical care patients, terminally-ill patients, or are likely to require advanced directives and/or DNRs, clients will be asked at admission whether they have such documents “active” (not expired/out of date) on file. For clients that have no directives for their pets, attending veterinarians and support staff may discuss the use of such directives if clients make a request, or if in the opinion of the veterinarian such discussion is warranted based on the medical condition(s) of the patient.
• All discussions pertaining to directives and life sustaining treatment must be recorded in the pets’ medical records.
• If clients wish to sign a DNR, a veterinarian must indicate to the clients or agents which medical treatments will be withheld and explain the rationale for such decisions. If a DNR is issued and signed, clients should be informed that even though certain treatments will be withheld, other treatments will be provided to ensure their pets’ comfort and relief from pain. • If a pet suffers cardiac or respiratory arrest, cardio-pulmonary resuscitation will be initiated unless a DNR order has been written and signed by a veterinarian and the client, and entered into that pet’s medical record. Owners will be charged for resuscitation services and emergent care in accordance with the hospital’s fee schedule.
• Determining the specifics of advance directives for pets that are regarded as family members is difficult. While owners cannot anticipate all the different medical decisions with which they may be faced, they should consider their treatment goals.
• Owners may wish to examine their attitudes toward the possible death of their pets and under what circumstances they would consent to a DNR.
• Some useful questions owners may wish to consider include:
o Could you provide supportive care to a pet that was incontinent, partially or completely paralyzed, needed multiple medications per day, or had a condition that altered its behavior? o How active and healthy is your pet currently? How old is your pet? Has your pet lived most of its adult life? Would age and activity level play a role in your decision making process?
o Do religious beliefs or finances play a role in decisions about your pet’s health care?
o What role should other family members and your veterinarian play in your decisions?
o How does your pet’s quality of life affect your decision? What are your expectations? What might be acceptable handicap(s) that you would feel comfortable managing longterm at home for your pet? What handicap(s) might you consider unacceptable? At what point would you consider euthanasia or a DNR?