The document discusses the differences between three types of advance healthcare directives: a durable power of attorney for healthcare, a living will declaration, and a do not resuscitate directive/order. A durable power of attorney appoints an agent to make healthcare decisions if the person becomes incapacitated. A living will allows a terminally ill patient to decline life-sustaining treatment. A do not resuscitate directive instructs medical professionals not to perform CPR if the person's heart or breathing stops. Each type of directive serves a distinct purpose and has different legal requirements regarding completion and implementation.

1. UNDERSTANDING YOUR
HEALTH CARE OPTIONS
The difference between:
 The Power of Attorney for Health Care Decisions
 A Living Will Declaration
 Do Not Resuscitate Directives/Orders
A BRIEF ARTICLE BY PAUL SHIPP, MANAGING ATTORNEY
OF THE MANHATTAN OFFICE OF KANSAS LEGAL SERVICES
800-723-6953
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Often in conversation about end of life issues we confuse the meaning and purpose of
Living Wills, Do Not Resuscitate Orders/Directives, and Powers of Attorney for Health
Care Decisions. The information presented here seeks to help the reader understand the
differences between each of these documents.
Durable Power of Attorney for Heath Care Decisions
A Durable Power of Attorney for Health Care Decisions is sometimes called the Healthcare
Power of Attorney. It is a legal document that allows a person to designate an agent to
make health care decisions for him/her during a period of disability or incapacity. The
person who holds the power of attorney is called the healthcare agent, or proxy.
The powers granted usually include the power to make decisions regarding hospitalization,
choice of physicians and long term care. The document also may include the power to
refuse or withdraw consent for the use of life sustaining procedures, even when the person
is in a coma or persistent vegetative state, and for organ donation and autopsy.
This document may be used to nominate a guardian for personal affairs and/or a
conservator for financial matters, in the event one needs to be appointed by a court. The
person creating a Durable Power of Attorney for Health Care must be an adult (at least 18
years old) and competent when the document is signed. A person is generally assumed to
be competent. The document must be witnessed, and witnesses may not be relatives, or
have a financial interest in the person's medical care or estate.
The Healthcare Power of Attorney may be effective immediately, or may be made effective
only when the person lacks the capacity (as determined by a physician) to make or
communicate decisions. A person designated as a healthcare agent may not cancel a
person's Living Will.
The person creating the Durable Power of Attorney for Health Care decisions may name a
family member to be his/her healthcare agent or some other third party. The agent may not
be an employee, owner, director or officer of a facility such as a hospital or nursing home
where the person is receiving treatment unless that person is a relative, or is bound to you
by common vows to a religious life.
The Durable Power of Attorney for Healthcare Decisions must be in writing, dated and
signed in the presence of two witnesses at least 18 years of age, neither of whom is the
agent named in the document. The witnesses may not be related by blood, marriage or
adoption, entitled to any portion of the estate, or directly financially responsible for your
health care. In the alternative to witnesses, the Durable Power of Attorney for Healthcare
Decisions can be acknowledged before a notary public.

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The healthcare agent has authority to make decisions for the patient when the patient is no
longer able to make or communicate decisions for themselves. The agent has a duty to
make decisions on behalf of the patient, and is required to follow the wishes of the patient.
The decisions made by the healthcare agent have the same force and effect as if they were
made by the patient. It is the duty of the attending physician to determine in accordance
with the law, when the patient no longer has the capacity to make decisions for themselves.
If the patient decides to revoke or change a Healthcare Power of Attorney the patient should
do it in writing, and have the revocation witnessed or notarized. The patient should also
destroy all copies of any previous Healthcare Power of Attorney and inform any attending
physician and his/her healthcare agent. Doing the revocation in writing ensures that
everyone will follow the patient’s wishes, and documents what has been communicated.
The Living Will (A Declaration)
A Living Will declaration is a signed and notarized (or witnessed) document that allows a
terminally ill patient to state in advance that his/her dying should not be artificially
prolonged. K.S.A. 65-28,101 et seq. This decision may be made only by the patient. It is
true that the patient may direct a person to sign for them, but the law does not allow anyone
but the terminally ill patient to make the actual decision. In other words, the decision to
have a living will cannot be delegated.
The Living Will is only effective when the patient is a terminally ill adult (at least 18 years
old). K.S.A. 65-28,102(e). The persons who witness the Living Will declaration may not
be relatives, or have a financial interest in the person's medical care or estate. The Living
Will applies only when the person has been diagnosed and certified as terminally ill by two
physicians. Terminally ill is usually taken to mean that death will probably occur within
six months, regardless of whether life-sustaining treatments are used. The Living Will is
not effectual when the person in a coma or persistent vegetative state, unless the person is
also diagnosed as terminally ill. A Living Will does not prevent pain relief, or other comfort
care from being given.
Please remember that The Living Will is a declaration. It only describes your wishes. It
does not serve the same purpose as a Do-Not-Resuscitate Order/Directive (DNR). In an
emergency, resuscitation will be provided, regardless of a Living Will, unless a DNR Order
has also been signed by a doctor.
It is the declarant’s responsibility to notify his/her attending physician of the existence of
the declaration. The physician should make a copy of the declaration part of the patient’s
medical records.
Other considerations include:

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1. The declaration is not effectual during the course of a patient's pregnancy.
2. The declaration can be revoked by the patient at any time by any of the following
methods:
a. By obliterating, burning, tearing or defacing in a manner indicating your
intention to cancel.
b. By writing a revocation and signing it or directing someone else to sign it,
or
c. By a verbal expression in the presence of an adult witness who signs and
dates a confirmation that the patient’s expression was made.
3. When the attending physician receives notification of the revocation, the time,
date and place should be noted in the patient’s medical record.
4. Signing a "Living Will" declaration should not affect the patient’s ability to obtain
life insurance or prevent comfort care from being provided.
A Do Not Resuscitate Directive/Order
In a nutshell, a DNR Directive is a signed, dated and witnessed document that allows an
adult to state in advance his/her decision that if his/her heart stops beating, or he/she stops
breathing that no medical procedure will be undertaken to restart the heart or breathing
processes. A healthy individuals usually does not have a DNR and 911 will not and should
not be called when the individual has a DNR.
The person executing a DNR must be a person who is an adult and competent when the
document is signed. The document must also be signed by the attending physician as
"medically appropriate" unless the person's church or religion recognizes treatment by
spiritual means only. A DNR Directive is not effective unless it is signed by a physician.
A Physician's DNR Order may be any physician's order (sometimes referred to as "no
code") in a medical care facility, an adult care home, or an emergency medical setting. A
DNR Order may be a separate document, or merely a physician's order in the patient's
record.
A patient’s DNR Directive must be in writing, and signed by the patient making the
declaration, dated, and witnessed by someone at least 18 years old. The witness may not
be related to the declarant by blood or marriage, or entitled to any part of the estate. The
witness may not be someone who is directly financially responsible for the declarant's
medical care.
A DNR Order established while the patient is admitted to a licensed medical care facility,
or adult care home will remain valid during transport to or from another medical care
facility or care home unless rescinded by the physician who is responsible for the care of
the patient.

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What is the legal basis of a DNR directive or DNR order?
Do Not Resuscitate Orders can be found in the Kansas Statutes at K.S.A. 65-4941 through
K.S.A. 65-4948.
If I am healthy, is a DNR Order necessary?
No, a DNR Order/Directive is not advisable for a person in good health whose life may be
saved by resuscitation in the event of an injury, choking, asthma attack, allergic reaction,
car accident, etc. If you are a healthy adult most physicians will not approve a DNR.
If a person wants to be thorough about all healthcare wishes, they should first consider
completing a Durable Power of Attorney for Health Care Decisions, and writing down their
wishes for care, should they become incapacitated. After a Durable Power of Attorney for
Health Care is signed and implemented a DNR Directive/Order may be considered, but
having a Durable Power of Attorney for Health Care is not required before one can have a
DNR Directive/Order.
What are the appropriate reasons for a DNR Directive/Order?
A DNR Directive/Order should not be signed without a specific reason in mind. The patient
should discuss with his/her physician any medical information they may need to know prior
to making a DNR Directive. The patient should find out if their doctor supports their
decision because the doctor must sign off on it before it is effective.
Some appropriate reasons for a DNR Directive/Order might be to ease pain and trauma for
a terminally ill person, to ease or prevent pain of an elderly or frail person unable to bear
chest compression, etc. or in situations where a person’s quality of life will not be restored,
enhanced or cannot be maintained, even if the resuscitation is successful.
Can the Agent for a Durable Power of Attorney for Healthcare sign a DNR Directive?
According to the K.S.A. 65-4942, in Kansas, a Durable Power of Attorney for Health Care
cannot sign a DNR Directive for the patient/principal; however, a DNR Directive can be
instituted by the Durable Power of Attorney for Health Care by communicating with the
attending physician the wishes of the agent on behalf of the patient. After communication
with a Durable Power of Attorney for Health Care and/or family members, a physician can
institute a DNR Order by noting the patient’s medical file.
If the patient is at home and/or in hospice care, the physician may be called by the family
or Durable Power of Attorney for Health Care, and a prescription pad/page may be signed
by the physician indicating the patient’s name and DNR Order on the prescription page.
Copies are always placed in the chart within the healthcare facility and should be visible at
all times in the home.

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Can a DNR Directive/Order be terminated/revoked/changed?
Yes, a DNR should be re-evaluated when the situation changes in the patient’s healthcare
status.
Is a DNR valid during surgery?
Generally, “No,” a DNR Directive/Order is usually not applicable during surgery as the
anesthesiologist must manage the patient’s heart rate and respirations during a surgery, and
if the patient ‘codes’ or does not have a heart beat or stops breathing, resuscitation will be
attempted as that is normal during the course of many surgeries. After surgery and recovery
new orders for a DNR Order can be revisited, and reinstated by the attending physician.
Does a DNR Directive have an expiration date?
No, a DNR Directive does not have an expiration date. A DNR Directive should be
revisited with the patient if healthcare status changes so that all staff understands the
patient’s wishes.
What should I do with the DNR Order when it is completed?
Usually the medical staff will handle this. The completed DNR Order should be posted in
the home and readily available to present to emergency medical responders, or facility
personnel. Copies should be given to anyone who will work with the patient.
If a Do Not Resuscitate (DNR) is written, what will not be done?
 NO chest compressions
 NO intubation
 NO defibrillation
 NO emergency drugs will be administered
 NO manual ventilation with a resuscitation bag will be performed
In other words if you have a DNR Order, NOTHING WILL BE DONE!

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The information in this booklet is provided as a public service by Kansas Legal Services,
It was compiled by Paul Shipp (Managing Attorney in the Manhattan Office of Kansas
Legal Services). It was written to provide you with helpful information regarding the
subject matters covered. This publication must not be used as a substitute for the advice of
an attorney. If you require legal advice then you should seek out a qualified, competent
attorney.
Distributed by the Manhattan Office of Kansas Legal Services, 104
South Fourth Street, Manhattan, KS 66502; Phone: 785-537-2943.
For assistance with Elder Law Questions, Call: 1-888-353-5337
To apply for assistance from Kansas Legal Services: 800-723-6953
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media, so that you can review them please feel free to contact the Manhattan Office of
Kansas Legal Services directly.
Copyright © 2016
By Kansas Legal Services
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provided it is done at no cost to the recipient.
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