For certain clients, the Guardian may determine it is best to establish a Do Not Resuscitate (DNR) for their client. Typically, a DNR is sought because the potential lifesaving measures taken by emergency medical staff to resuscitate the client will end up doing more harm, often breaking bones without successful resuscitation.
In order to obtain a DNR within a Guardianship, a court order is usually needed, so it is a good idea to consult with your attorney about the matter if you think a particular client may need a DNR, preferably in advance of a crisis.
There are generally three things that should be gathered in order to initiate a petition for a DNR. They are:
Medical Condition Information: Request a letter (maybe even more than one letter) from the client’s doctors, such as a primary care physician, cardiologist, neurologist, infectious disease, or other relevant doctors. If none of those are available, you can also get a letter from the hospice director, or the attending physician at the hospital, if needed.
The letter should provide a glimpse of the individual’s medical condition in laymen’s terms, not in medical terms, explaining the entirety of their condition, the likelihood of success in resuscitation efforts, the potential quality of life after resuscitation, and the doctor’s opinion of the inappropriateness of a full code status on this particular patient.
Historic Beliefs and End of Life Documents: Of course, we always hope to have fully executed, well drafted Advanced Directives, like a Living Will, for every client making their wishes well known, but we can use almost anything that shows the client’s belief system about the end of life. Items like organ donor cards, hand written notes and signed letters about their wishes, comments in Wills or burial arrangements, or anything else that clearly shows what the client would choose for themselves if they had capacity, work well for proving the client’s wishes.
Consent / Support from Family and Close Friends: Many times, clients will have conversations with people in their life about their end of life wishes. When a client has family, friends, clergy, co-workers, or other individuals willing to provide, in writing, the client’s wishes, it can often work as supporting documentation for obtaining the DNR. However, this can also be a problem when two people state very different interpretations of what the client wants with regards to their end of life wishes.
In a perfect world, a Guardian will provide all three to the court when petitioning for the DNR, however, more often than not we only have two of the three.
Regardless, the decision to grant the Order to Initiate a DNR is up to the judge. Some judges will sign these petitions when they are simply sent to the courts. Others will require a hearing every time. Some judges feel that guardians do not even need a court order to make this medical decision.
That’s why, as a Professional Guardian, it is important to gather the proper documentation, and speak with your attorney in advance to get a plan in place for the client. That way you’re not stuck when you get that call at 2 am from the ICU, and they need a fast answer as to the client’s code status.
When it comes to adult guardianship in Florida, there are four common types of guardians. Depending on the client’s particular needs, one type of Guardian may be better suited for a specific case than another.
Here is a breakdown of each of the common types of Guardians for adults in the State of Florida:
Professional Guardian: Most commonly involved when there are no willing, interested, appropriate, or available family or friends able to serve as Guardian. A Professional Guardian is also often appointed when there are multiple feuding family members all wanting to be the guardian, and the courts determine that an independent, Professional Guardian is the better option.
Public Guardian: A State recognized entity, usually a non-profit agency, funded through public and grant dollars. Public Guardians serve individuals with little to no assets, usually referred to as Pro-Bono clients.
Family Guardian: (In this context as relating to adults only) A family member or friend who is willing, able, and appropriate to serve as the guardian for the individual who is in need of a decision maker for the Person and/or Property.
Corporate Guardian – Of the Property: This is usually a trust entity, like a bank or trust department of a financial institution, managing the funds and assets of an individual determined to be unable to handle their own financial affairs.