Many people get scared of the idea of being intubated in the event of a medical emergency. There is good reason to be worried about it: it can cause injury or other health issues. The potential consequences of intubation, however, are not very common. What's more common is the life-saving impact of it. But in the end, it's the choice of the individual – you have to weigh the benefits and the risks and determine what you prefer. You want to be proactive, though, and not wait because in the event a medical emergency occurs, you may not have a choice.
Hopefully, a medical emergency never arises where you would need intubation. At the Law Office of Catherine Chukwueke, our estate planning attorney in California wants you to be prepared in any case. As part of your estate plan, you can have a Do Not Intubate (DNI) order created if that's your choice. We will review your specific circumstances and explain what elements of an estate plan will protect you and your interests. A comprehensive estate plan is something each person over the age of 18 should not only think about but create and update on a regular basis.
Contact our estate planning attorney based in California today at 310-213-7711 to schedule a consultation and to make sure your estate plan has all the components you need to safeguard your finances, your assets, your health, and your future.
What Is Intubation?
Intubation is a medical procedure that involves inserting a tube into the trachea to assist with breathing when a person cannot breathe on their own. It's often used in emergencies, such as during cardiac arrest or when someone has low oxygen levels or severe injuries. Intubation may also be done routinely before surgery due to anesthesia.
Types of Intubation
There are different types of intubation based on the location and purpose of the tube placement:
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Nasogastric Intubation: A tube is inserted through the nose and into the stomach, often to remove air or deliver food and medication.
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Endotracheal Intubation: A tube passes through the nose or mouth into the trachea to assist breathing during emergencies or surgery.
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Fiber-optic Intubation: This method involves using a fiber-optic camera to guide the tube through the throat, typically used for difficult intubation cases.
Risks of Intubation
Though intubation is often a life-saving procedure, it does carry risks, particularly in emergency settings. Some risks include:
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Incorrect Tube Placement: The tube might enter the esophagus instead of the trachea, which can cause complications, including a collapsed lung.
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Infections: Pneumonia and other infections can develop due to the procedure.
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Physical Injury: Injuries to the mouth, teeth, or vocal cords, as well as trauma to the chest cavity.
However, these risks are rare compared to the life-saving benefits of the procedure.
Common Reasons to Have a Do Not Intubate (DNI) Order
Given the minimal risks compared to the life-saving benefits, what are the reasons why someone might decline intubation, especially in medical emergency situations? Though there are many reasons, including religious beliefs, there are three primary situations where people often opt for DNI orders.
- Terminal illness. When someone has a terminal disease, they may decline intubation because it may only prolong the discomfort, pain, and the inevitable. Examples of terminal illnesses include cancer, liver disease, and dementia.
- Advanced chronic illness. When someone has an advanced chronic illness, they may be living in a lot of pain and know that, when they are at the end-of-life stage of the disease, their heart or breathing may stop, and they may choose not to prolong their pain and suffering. Examples of advanced chronic illnesses include heart disease or COPD.
- Personal preference. As already indicated, intubation has inherent risks. It is also very uncomfortable. Older adults particularly may choose that they prefer to be intubated even if for lifesaving purposes.
Do Not Intubate (DNI) Order
A DNI order is a legal directive that informs medical professionals that a person does not want to be intubated in the event of a medical emergency. This order may be included in your advance healthcare directive or as part of your durable power of attorney for healthcare.
How DNIs Work in California
A DNI order instructs medical professionals that a person does not want to be intubated, even in an emergency or life-threatening situation.
This means if someone with a DNI has difficulty breathing or stops breathing–and mouth-to-mouth or manually assisted breathing doesn't work–they will not be intubated.
How to Obtain a DNI
To create a DNI order in California, you will typically work with your physician to complete a form that is then added to your medical records. You can include a DNI order as part of your estate planning documents, such as:
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Advance Healthcare Directive
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Living Will
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Durable Power of Attorney for Healthcare
These documents provide clear instructions to medical professionals about your healthcare preferences if you are unable to communicate your wishes.
DNI vs DNR
A DNI order is separate from a do-not-resuscitate (DNR) order. A DNR instructs medical professionals that in the event you stop breathing or your heart stops, you do not want the following administered:
- Chest compressions, also referred to as CPR
- Defibrillation, using electricity to try to restart the heartbeat
- Intravenous (IV) medications, like cardiac drugs
- Intubation
It's possible to have either a DNI or DNR or both. If someone has a DNI but not a DNR, medical staff may use chest compressions and cardiac drugs to try and resuscitate them but cannot intubate them.
Can Anything Override a DNI Order in California?
When prepared properly, a DNI is a legally binding document. Medical professionals or family members cannot override it.
However, you can withdraw a DNI order at any time should your situation or feelings towards it change. If someone is receiving long-term care, the treating team may periodically confirm with them whether they wish for their DNI to remain in place.
Depending on the circumstances, when someone has a DNI their treating team may be able to use measures other than intubation, like oxygen therapy or a BiPAP machine (a machine that pushes air into a patient's lungs through a face mask or nasal plugs).
Factors to Consider Prior to Signing a DNI in California
Signing a DNI is a serious matter that potentially involves the refusal of life-saving treatment. For these reasons, it is important to discuss it carefully with your doctor. They are familiar with your medical history and current condition and so are best placed to answer any questions you have.
Before signing a DNI, you may wish to discuss with your doctor:
- Whether you want a DNI, a DNR, or both?
- What the risks of intubation might be with specific reference to your condition?
- What is the process for withdrawing your DNI, should you wish to do so?
You can also discuss a DNI and other related health documents, such as a DNR or living will, with a lawyer in the context of estate planning. It is a significant part of a comprehensive, proactive plan that makes sure all aspects of your life are safeguarded.
Contact an Estate Planning Lawyer in California Today
It is never easy to think about the end of your life, but being proactive about it can save a lot of heartaches later. As part of your estate plan, you want to include both protections for your finances and assets as much as for your health and overall well-being.
At the Law Office of Catherine Chukwueke, our estate planning attorney in California will guide you through the process of creating and executing a solid estate plan that protects you, your assets, your wishes, and your heirs. If you already have an estate plan, but you have experienced major life events or changes (e.g., children, marriage, illness, etc.), it may be time to update it. As such, we will review and update a current but old estate plan as well and will continue to do so through all stages of your life. Contact us today by filling out the online form or calling us at 310-213-7711 to schedule a consultation.
