In the emergency department (ED), life-saving decisions have to be made quickly. Importantly, they must also be made within the legal parameters and stated wishes of each patient.

As physicians, we have the important responsibility to be the best advocate we can for our patients, from the moment they arrive at our doors. Our first concern is to assess the needs of the patient – but, if those needs require a decision to be made for CPR, ventilator use or comfort care, we need to know if our patient has any advanced directives in place.

Advanced directives serve as a doctor’s primary set of instructions for this decision making. The only people that can supersede an advanced directive are the power of attorney or the patient’s kin as listed. If there is not an advanced directive, we must listen to the next of kin and help provide the most ethical solution possible based on what the family chooses.

It is crucial that physicians in the ED remember the steps and procedures of an advanced directive when making decisions for their patients:

  1. If no family members are present and you are unaware of an advanced directive, make the best decisions for your patient with the highest probable benefit. And, importantly, make sure to note this in your chart.
  2. If there are family members present and no advanced directive, go by the next of kin as outlined by your state.
  3. If there are family members present, but none of them are listed on the advanced directive, stick with the patient’s wishes as listed on the advanced directive.
  4. If the power of attorney is present and decides to supersede, make sure they fully understand the effects of their decision.

At American Physician Partners, we work hard every day to ensure that providers at our facilities remain compliant and follow all laws regarding advanced directives to give our patients and families the best outcomes and experience possible.