Capacity and context
Document that the patient understands the nature and consequences of the choices. Record the diagnosis, prognosis uncertainty, and the clinical scenarios discussed.
Clinical page
Help patients turn fear into usable treatment instructions.
A useful directive is not just “not for ICU.” It explains capacity, values, unacceptable outcomes, specific refusals, and what comfort care means in practice.
Translate treatments
Use plain language: breathing tube, breathing machine, kidney machine, feeding tube, blood-pressure drugs, shocks, chest compressions, drip fluids, and comfort medicines.
Trial limits
Where the patient wants limited resuscitation, document triggers and stopping points: witnessed arrest, reversible cause, about 10 minutes of CPR, 3 to 4 shocks, or no escalation to ICU.
Comfort is active care
Specify analgesia, anxiolysis, antiemetics, secretion management, dyspnoea relief, mouth care, turning, privacy, spiritual care if requested, and family presence.
Future loss of capacity
Ask whether the directive should still apply after dementia, stroke, brain injury, infection, or other neurological loss of decision-making capacity.
Suggested documentation structure
- Patient identity, capacity, interpreter needs, and who attended.
- What outcome the patient would accept.
- What outcome the patient would refuse.
- Specific treatment refusals and any time-limited trials.
- Preferred decision-maker and family dynamics.
- Location of the legal document and copies provided.