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Do Not Resuscitate Order For Harvard Employees

What Is It?

As a Harvard employee, you have the right to decline medical treatment, even if you die as a result of your decision. Depending on your medical condition, your prognosis, and your views on the quality of life, you may wish to refuse lifesaving measures, such as cardiopulmonary resuscitation (CPR). Executing a do not resuscitate (DNR) order is one way of doing this. A DNR is a doctor's order that tells all other medical personnel not to perform CPR if you go into cardiac arrest. Cardiac arrest occurs when your heart stops beating, blood flow to your brain stops, and you stop breathing. If the blood flow is not quickly restored, permanent damage to the brain and other organs can occur. CPR simulates heartbeat and breathing, while attempting to restart these functions.

The term CPR actually encompasses a variety of separate procedures, including cardiac compression, endotracheal intubation, assisted ventilation, defibrillation, and cardiac medications. Most states recognize two types of DNRs. One is effective only while you are hospitalized. The other is used by people outside the hospital--for example, nursing home residents, hospice patients, and even those who are not receiving medical treatment.

Typically, terminally ill patients and elderly individuals execute DNRs to avoid prolonging their final illnesses. However, some states allow healthy adults to execute the orders, as well. Depending on the laws of your state, a DNR used outside the hospital may be called a 'pre-hospital DNR,' 'out-of-hospital DNR,' 'outpatient DNR,' 'DNR for EMS,' or 'CPR directive.' As a result of your request, your doctor generally notes an in-hospital DNR order on your chart. Out-of-hospital DNRs take various forms, depending on the laws of your state. ID bracelets, MedicAlert necklaces, and wallet cards are some methods of noting DNR status.

When Can It Be Used?

Availability of DNRs Is Determined By State Law

Not all states have DNR laws. For Harvard employees, you may want to consider how your state's laws govern whether DNRs are permissible, who can execute a DNR, and what form the order must take. These laws may permit in-hospital DNRs, out-of-hospital DNRs, both of these, or neither of these. Some state laws allow any person of legal age to execute a DNR, while others permit DNRs only for individuals with terminally ill conditions. Some states allow children to participate in decisions regarding DNR in certain cases. Check the laws of your state and any other states where you spend a significant amount of time.

Strengths

Allows You to Exercise Choice In Medical Treatment

Cardiopulmonary resuscitation (CPR) has produced some miraculous results when used on normally healthy individuals in trauma situations. However, it can be a painful and even violent procedure. Its effectiveness is limited when used on terminally ill or hopelessly deteriorated patients. In some cases, CPR only delays the moment of death.

For example, CPR could restore your heartbeat, but if permanent brain or organ damage occurs during cardiac arrest, you may be dependent on life support machines. Executing a do not resuscitate (DNR) order allows you to choose a natural death.

Example(s): Hal is hospitalized with a terminally ill condition. He is on a respirator and knows he has only a short time to live. Hal consults his doctor and learns that the laws of his state permit in-hospital DNRs. This will allow him to forego CPR if his heart fails. Hal asks his doctor to execute a DNR as soon as possible. The following week, Hal's heart stops. Because of Hal's DNR, hospital personnel do not attempt CPR.

Specifically Intended for an Emergency Situation

If you go into cardiopulmonary arrest, your DNR lets medical personnel know that you don't want CPR. Because of the emergency nature of this situation, other types of advanced directives are usually not timely enough to accomplish this goal.

Tradeoffs

Extremely Limited Usefulness

Although a do not resuscitate (DNR) order is a very powerful instrument, it is only effective under specific conditions. Generally, a DNR comes into play only if you go into cardiac arrest, and it frequently only allows you to refuse cardiopulmonary resuscitation (CPR), although in some states it may allow you to decline other drastic medical treatment as well. A living will or durable power of attorney for health care may be needed to convey other medical treatment instructions, such as your wishes regarding life support and intravenous feeding.

Out-of-Hospital DNR May Not Be Effective In Other States

As a Harvard employee, it is beneficial to understand how an out-of-hospital DNR that is valid in your state may not be valid in other states. Therefore, if you spend a significant amount of time in another state, you should find out whether that state's laws recognize DNRs, whether you are eligible to have a DNR in that state, and what restrictions are placed on the form of the DNR.

Doctors May Be Hesitant to Broach This Topic or Reluctant to Write a DNR

If you are hospitalized with a serious illness, your doctor may not bring up the option of executing a DNR. If you don't want to be resuscitated, you should initiate this discussion with your doctor. Also, studies indicate that many doctors are slow to write DNRs, even when they are aware of their patients' preferences, although the reasons for this vary. If you are a Harvard employee and want to ensure your wishes are followed, you should touch base with your doctor to make sure the DNR is placed on your chart.

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How to Do It

Research Your State's Laws Regarding Dnrs

Not all states provide for these orders. Each state has its own eligibility requirements, particularly for out-of-hospital DNRs.

Discuss Your Wishes With Your Doctor

Your doctor should be able to provide information on your prognosis and counsel you on your options. If you are a Harvard employee, your doctor's signature will most likely be required on any DNR you execute.

Execute Your Out-of-Hospital DNR Properly And Keep It With You

If you are a Harvard employee interested in DNR, you must consider how if your state allows out-of-hospital DNRs, there is probably a required format for the order. Examples of state-required DNR formats include ID bracelets, necklaces, wallet cards, and letter-size forms. If your DNR is not in the required form, it may not be honored. If medical personnel can't find your DNR order, they are obligated to give full and immediate care. Thus, it is extremely important to execute your DNR order properly and keep it with you (or in an appropriate place) at all times.

Example(s): Hal is a resident of an assisted-living facility. Hal is 89 years old and feels he has lived a good life. He does not want to die in a hospital or be dependent on machines for his survival. Hal discusses his feelings with his doctor. Hal's doctor suggests executing an out-of-hospital DNR, which will instruct medical personnel not to perform cardiopulmonary resuscitation (CPR) if Hal goes into cardiac or respiratory arrest. Hal agrees and receives an ID bracelet noting his DNR status. Hal wears his bracelet faithfully. Six years later, Hal's heart fails as he jogs in the park. Medical personnel arrive on the scene, but immediately notice Hal's DNR ID bracelet. CPR is not attempted.

Tell People About Your Decision

In general, other people cannot reverse your decision once you execute a DNR. As a Harvard employee however, if your DNR is misplaced or for some reason is not followed, it would be important for your family and friends to understand your wishes. Although this topic may be difficult to discuss, those close to you are more likely to support and uphold your decision if they understand how you feel and why you feel that way. If you have appointed a representative in a durable power of attorney for health care (DPAHC) , it is especially important that this person be aware of your decision.

Coordinate All Advanced Directives

Since a DNR is so limited in scope, you may wish to establish a living will and/or DPAHC as well. If you do so, make sure your wishes are stated consistently throughout these documents. In some states, the most recent document will govern if there is a conflict, so you must make sure your wishes are clear.

Tax Considerations for Harvard Employees

Income Tax

None

Gift And Estate Tax

None

Questions & Answers for Harvard Employees

What If You Go Into a Coma Before Executing Your DNR, And You Can't Express Your Wishes?

Your healthcare representative, if you have appointed one, may be able to have a DNR executed on your behalf. As a Harvard employee, there must be evidence that this is what you would want. You might include these instructions in your durable power of attorney for health care , especially if the laws of your state do not allow out-of-hospital DNRs. Be aware, however, that this method of instruction is useless in an emergency if your representative is not present. In some states, with your family's consent, your doctor may be able to execute a DNR on your behalf. Again, it would be unwise to rely on this course of action in an emergency.

Can You Change Your Mind?

Yes, it is possible to revoke a DNR order. If you have an out-of-hospital DNR, you may be able to revoke it by simply removing the bracelet or the wallet card. However, some states also have a database of DNR patients. If this is true in your state, you may need to take additional steps to revoke your DNR. When your doctor writes the DNR, ask what steps are necessary to revoke the order.

Additionally, medical personnel must give emergency care to anyone who requests it. For example, Emergency Medical Service guidelines in Wisconsin instruct personnel to perform cardiopulmonary resuscitation (CPR) if a person rips off his or her DNR bracelet or asks for CPR during cardiac arrest.

What are the key distribution options available to employees at Harvard University upon retirement, and how do these options differ regarding tax implications? Employees should understand both the annuity options and lump-sum distributions available under the Harvard University Retirement Plan, as these can significantly affect their financial outcomes in retirement. Harvard University provides various choices depending on the lump-sum value, and it's essential to analyze each choice carefully to maximize retirement benefits.

Key Distribution Options: Upon retirement, Harvard University employees can choose between a lump-sum distribution, a rollover to another retirement account, or an annuity with different options, including a single-life annuity or joint and survivor annuity(Harvard University Reti…). Lump-sum payments may lead to immediate tax liabilities, while annuity options offer more tax-deferred growth(Harvard University Reti…).

How does the choice of an annuity payment method impact the long-term financial security of retirees at Harvard University? Employees need to weigh the advantages and disadvantages of single life versus joint and survivor annuities, considering not only their own financial needs but also those of potential beneficiaries. The decision can affect monthly income levels and the benefits passed on to surviving partners or dependents.

Impact of Annuity Payment Method: Choosing a single-life annuity maximizes monthly payments but provides no benefits after the retiree’s death. A joint and survivor annuity reduces monthly payments but ensures ongoing income for a surviving spouse or beneficiary, offering more long-term financial security for both parties(Harvard University Reti…).

What specific conditions must be met for a retired employee of Harvard University to elect the Consolidated Harvard Annuity Option (CHAO), and what benefits might this offer? Understanding the eligibility criteria for CHAO and its implications on retirement planning will help employees make informed decisions. The CHAO allows for a potential increase in annuity benefits, but there are specific deadlines and requirements that participants must adhere to.

Consolidated Harvard Annuity Option (CHAO): To elect the CHAO, employees must terminate their employment after April 30, 2006, and have a Basic Retirement Account balance exceeding $1,000. They must elect the CHAO within 60 days of termination to exchange their investment account for a higher annuity(Harvard University Reti…)(Harvard University Reti…).

How can employees at Harvard University ensure that they have properly designated beneficiaries within their retirement plans, and what are the ramifications of failing to do so? The importance of keeping beneficiary designations up to date cannot be overstated, as it impacts how benefits are distributed upon the participantâ€™s death. Employees must familiarize themselves with the required forms and the potential consequences of having outdated or incorrect designations.

Beneficiary Designations: Employees should ensure their beneficiary designations are up to date by completing the appropriate forms. Failure to do so could result in benefits being distributed according to marital status or to unintended recipients(Harvard University Reti…).

In what ways do the spousal consent rules affect the retirement options for married employees of Harvard University, and why is this a critical aspect to consider when planning for retirement? Understanding the spousal consent requirements is vital for retirees since failing to adhere to these regulations can lead to unintended consequences, including issues related to benefit disbursement. Employees should seek to navigate these requirements carefully to secure their desired benefit structure.

Spousal Consent Rules: Married employees must obtain spousal consent, witnessed by a notary or plan representative, if they choose a retirement distribution option that does not provide survivor benefits to their spouse(Harvard University Reti…). Failure to adhere to these rules can result in complications with benefit disbursement(Harvard University Reti…).

How does the $1,000 threshold affect retirement distribution choices for employees retiring from Harvard University, and what specific options are available once this threshold is considered? Employees need to be informed about the options that arise based on the value of their Basic Retirement Account when making distribution decisions. Knowing whether an annuity or lump-sum option is available can significantly influence retirement planning and benefits.

$1,000 Threshold: If an employee's Basic Retirement Account value is $1,000 or less, they must take a lump-sum payment or rollover, as annuity options are unavailable. The lump-sum is subject to tax withholding unless rolled over(Harvard University Reti…).

What steps should employees at Harvard University take if they wish to defer their retirement distributions, and what factors should they consider before making this decision? Deferring distributions can offer various tax advantages and impact retirement income strategies. Employees should evaluate their financial situations, anticipate future needs, and understand the timelines involved in the deferment process to make sound choices.

Deferring Distributions: Employees can defer their distributions until the April 1st following the year they turn 70½. Deferring can offer tax advantages and allow time for the value of retirement funds to grow(Harvard University Reti…).

What are the consequences of electing a lump-sum distribution from a retirement account at Harvard University, particularly in terms of immediate and long-term tax implications? Employees considering a lump-sum distribution must recognize that such options can lead to significant tax liabilities and potential penalties, especially if improperly managed. A thorough understanding of these financial repercussions can aid in making choices that align with retirement goals.

Lump-Sum Distribution Consequences: Opting for a lump-sum distribution can result in substantial tax liabilities, including early withdrawal penalties if under age 59½. However, rolling the distribution into another retirement account can mitigate tax impacts(Harvard University Reti…).

How can employees contact the Harvard University Retirement Center to learn more about their retirement plan options, and what information should they prepare before reaching out? Understanding how to access information and ask the right questions is crucial for employees looking to navigate their retirement options effectively. Having personal details and specific inquiries ready when contacting the Harvard University Retirement Center will facilitate a more productive dialogue.

Contacting the Retirement Center: Employees can reach the Harvard University Retirement Center at 800-527-1398 for information. They should have their pension statement, retirement account details, and any specific questions prepared(Harvard University Reti…).

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Rollover Options: Rolling over retirement benefits into another employer’s plan or an IRA allows employees to maintain tax-deferred growth. It is crucial to compare fees, investment options, and withdrawal rules before making a decision(Harvard University Reti…).