“Do Not Resuscitate” Doesn’t Always Mean “Do Not Resuscitate”

Updated for 2023

With an Advance Health Care Directive, you can make “end of life” decisions. You can choose to die naturally, without life support. However, if your heart stops beating, emergency medical personnel will resuscitate you, even if you have an Advance Health Care Directive.

Some people who suffer pain or have a terminal illness would rather not be resuscitated. To allow people to refuse resuscitation, the “comfort care only” law was enacted way back in 1994. It provided a way for others to know quickly if a person does not want to be resuscitated when her breathing or heart stops. It required wearing a special bracelet or necklace. When emergency medical personnel see the bracelet, they are to provide only “comfort care,” without trying to resuscitate the person.

There was a problem with the law, however. Even if you were wearing the special bracelet, a person could resuscitate you if his conscience requires it.

On July 16, 2009, House Bill 1379 became law without Governor Lingle’s signature. This new law is called Physician Orders for Life-Sustaining Treatment (POLST). These “Physician Orders” cover tube feeding, like an Advance Health Care Directive, and also cover resuscitation, like a “comfort care only” document. You can request to not be resuscitated if your heart stops beating. It also covers “medical interventions”. You can choose comfort measures only, limited additional interventions or full treatment. These are actual doctor’s orders, which both you and your doctor sign. It is a two-sided form, with information on both the front and back. These orders must be followed by medical personnel if they know that you have a POLST form. Under the “comfort care only” law, medical personnel can resuscitate you against your wishes and are protected from lawsuits.

Under POLST, if someone knows you have a POLST form and resuscitates you against your wishes, you could probably sue that person. Therefore, if the emergency medical personnel know about your POLST form, they are more likely to follow your “do not resuscitate” wish than if you had a “comfort care only” document.

But there is also a problem with POLST. It does not provide for a special bracelet for emergency medical personnel to know that you have a POLST form. In order to make the POLST form clearly visible, it is usually printed on bright lime-green paper. It is recommended that you post a copy where it can easily be seen, such as on your refrigerator, bedroom door, or on a bedside table. If you are in a hospital or nursing home, perhaps it should be posted near your bed. You should tell your relatives and friends that you have such orders and what your wishes are.

The POLST form may be downloaded from the Kokua Mau Web site at https://kokuamau.org/polst/. Kokua Mau is an organization concerned about end of life care. They played a major role in getting the POLST law passed in Hawai’i. They have recommended printing out the form on 8 ½ x 11-inch paper, with the color being Lime No.102053 from Kaleidoscope. A black ink on white paper is legal, and even a copy is acceptable, but the bright lime green color will make it easier for people to spot it in an emergency.
One thing to keep in mind about the POLST is that it contains physician orders—or instructions from your doctor. So it must be filled out by your physician or authorized medical professional, and you or your legal representative must sign it as well. It would be a good idea to keep a copy of the POLST form in your purse or wallet, so emergency medical professionals can find it in case of an emergency when you’re not at home.

Kokua Mau also played a major role in getting the “Our Care, Our Choice Act” passed by the Hawaii legislature and signed into law by Governor Ige back in 2018. I’ll write more on this law in a future column.