“Living Will,” “Durable power of Attorney,” “Healthcare Proxy,” and “Do not Resuscitate”


Emergency Medical Services (EMS) are always the most sought after medical interventions by friends and relatives whenever a person is on the verge of death (Jesus, et al., 2014). In many instances, the medical responses prolong the patient’s life, even if with an extra living hour, day or any other quantifiable length of time. However, the law has a different perspective regarding the EMS interventions, especially if the patient is willing or not to be subjected to the medical interventions (Jesus, et al., 2014). Therefore, philosophical concerns arise in the essence of prolonging one’s life or allowing the patient to succumb without the intervention, a situation that may assist an individual overcomes the sufferings. In the United States, the law is quite clear on some basis where the patient’s will should be allowed to prevail (Jesus, et al., 2014).The rationale of this paper is to evaluate the legal provisions of the US on “Living Will,” “Durable power of Attorney,” “Healthcare proxy,” and “Do not resuscitate (DNR)” as stipulated by the EMS.

Living Will

The “living will” is a document intended to communicate a person’s end-of-life decisions in writing (Eisendrath & Jonsen, 1983). Often, a person may not be in the right state of mind of physical ability to pronounce his/her intentions when at the verge of death. The United States’ law allows for prior preparation through a written document, which is regarded as the living will. Through the living will, a person can choose an individual who would be responsible for making his decisions when not in a position to do so (Eisendrath & Jonsen, 1983).  Therefore, the person allows the law to intervene if his/her wishes are not honored at the point of incapability. In other instances, a person may stipulate that no resuscitation procedures should be applied to him at the time of death. Therefore, the person outlines their preferred intervention mechanisms if faced with an emergency or even when faced with an uncertain outcome of such a procedure like the surgery. It is worth noting that the “living will” may be amended by the owner if the selected agent ceases to be the preferred person to make their decisions (Eisendrath & Jonsen, 1983).  In fact, the US law stipulates the applicability of the living will and the consequences that would be subjected to a physician who is perceived to have ignored the patient’s living.

Durable Power of Attorney

A person may be mentally incapable of making sober decisions because of such issues as mental illnesses. The “durable power of attorney” is adopted when a person cannot explain what kind of medication he/she requires or even how his/her estate should be managed (Siner, 1989). In essence, the document is only effective when an individual becomes incapacitated and cannot handle matters independently. In the US, the power of the attorney allows the chosen person to handle matters of finances and medical care on behalf of the patient (Siner, 1989). While one may require making separate documents for finances or medical attention, “the durable power attorney” may be revoked when the person involved has recovered. Therefore, the US law is explicit in the entire aspect of the durable power of attorney. The specific position of the US law is that the “durable power of attorney” is a legal document or provisions until the grantor dies.

Health Care Proxy

Another document used as a legal instrument in the US is the “health care proxy.” It indicates the appointed agent who acts on behalf of a patient or a person who is by law incapable of making own decisions or executing the specific health care decisions (Siner, 1989). However, the proxy may be prepared earlier, and the person continues with the decisions until confirmed legally incompetent to make decisions. At least 49 states in the US and Colombia district have adopted the use of the health care proxy. Among other important elements of the proxy is that the individual may involve a lawyer in drafting it and at least two witnesses to preside and ensure the sanity of the individual and the agent is confirmed when signing the document (Siner, 1989). Furthermore, the copies should be issued to the health care provider, the agent, and family or friends. However, the individual concerned must retain a copy

Do Not Resuscitate (DNR) Order

In other instances, especially at an old age or in the case of uncertainty, one may be sure that a medical condition being suffered may not be curable. At some point, one may decide to reject any efforts by the loved ones or the physician to do a CPR (cardiopulmonary resuscitation procedure) in an emergency (Partridge, et al., 1998). The decision is made when one is sober, and only a doctor writes the order after talking with the patient. However, it is worth noting that every state in the US has different directives in preparing the order document (Schears, et al., 2004). As such, no other documents like the “health care proxy” or the “living will” may be consulted in the processes of EMS involving CPR procedures, except the DNR order.

Case Studies

Karen Ann Quinlan Case Study

In 1975, the United States experienced a historical case involving medical intervention and the law. The case involved Karen Quinlan, who underwent CPR after suffering a comma before being rushed to the hospital for admission (Moskop &  Iserson, 2001). As part of the medical procedure, she was put into breathing aid of a ventilator that her parents later blamed for causing much suffering. After the parents had failed to convince the physicians to remove the ventilator, they sought legal intervention. In fact, the courts were equally hesitant to their demands, which entailed the termination her life for the sufferings she was going through. The case involved the lack of prior decisions on the procedures to be observed in the case there was an eventuality. The law would, therefore, argue that Karen’s right to live exceeded her parent’s rights to have her sufferings terminated.

MVC Victim

In another case, many motor vehicle collision victims often suffer permanent disabilities. The physicians and family members are faced with the challenge of choosing between the alternative intervention methods.  In such an instance, an MVC victim had written his living will in opposition to a possible radiation exposure and c-spine evaluations. Whereas the family members and the physician were confident that a procedural intervention would save the victim’s life, the US law required the living to be respected (Sochor, Deflorio, & Singal, 2008).


As stated from the discussion, there is a notable difference in the legal provisions of the different states in the US as indicated by the EMS and the individual wills. In fact, most states recognize their applicability, including the living will, a durable power of attorney, a health care proxy, and a ‘Do not resuscitate’ (DNR) order. In all the provisions, the enforcement of the documents would require a legal interpretation and the confirmation that the individual wrote them while in a sober mind.



Eisendrath. S. J. & Jonsen, A. R. (1983). The living will: Help or hindrance? JAMA. 1983; 250(20):2789-2789.

Jesus, J. E. et al., (2014). Physician Orders for Life-Sustaining Treatment and Emergency Medicine: Ethical Considerations, Legal Issues, and Emerging Trends. Annals of Emergency Medicine, 64(2): 140-144

Moskop J. C. &  Iserson, K. V. (2001), Emergency physicians and physician-assisted suicide, part I: A review of the physician-assisted suicide debate. Annals of Emergency Medicine,  38(5): 570–575

Partridge, R. A. et al., (1998). Field experience with prehospital advance directives. Annals of Emergency Medicine, 32(5): 589–593

Siner, D. A. (1989). Advance directives in emergency medicine: Medical, legal, and ethical implications. Annals of Emergency Medicine, 18(12):1364–1369

Schears, R. M. et al., (2004). “Do not attempt resuscitation” (DNAR) in the out-of-Hospital setting. Annals of Emergency Medicine, 44(1): 68-70

Sochor, M. R., Deflorio, P. &  Singal, B. (2008). 147: GLASS Rule: Automotive Glass Left Intact Associated With Safe Cervical Spine. Annals of Emergency Medicine, 51(4): 516

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