Imagine someone you love is dying at home. They've told everyone they don't want to be resuscitated, and they've written it into their advance directive. Then someone panics and calls 911. The paramedics arrive, but an advance directive isn't an out-of-hospital DNR order. Where emergency crews require a recognized medical order, that directive alone will not stop CPR. Your loved one can be carried away for treatment they explicitly refused.
Or you've signed a DNR, believing you've settled what happens if you become seriously ill. Then you're hospitalized, unable to speak, and placed on a breathing machine. A DNR addresses resuscitation when your heart or breathing stops. It doesn't, by itself, refuse intubation or other treatment before that happens. The document you signed never covered what you thought it did.
Or like many of us here, you live off-grid, or close enough to it. You've built your life on your own terms, surrounded by people you've chosen. Perhaps want to die on the land, without being taken to a hospital. But someone calls 911, and suddenly the outside world is at your door. Without the right medical orders, an ambulance crew can begin treatment and take you away despite everything you've told your people. With a properly completed, locally recognized POLST, MOLST, or out-of-hospital DNR, emergency workers can have the authority to respect specific treatment refusals. Even if you end up in a hospital, the right orders can help protect decisions about resuscitation, breathing machines, and other interventions. Living outside the system doesn't mean its rules won't reach you. Knowing which orders it recognizes can make all the difference.
Or you've completed a POLST or MOLST, only to cross into a province or state where that particular order isn't recognized as an instruction emergency workers can follow. Your decisions haven't changed; but the rules governing who will honor them have.
These aren't obscure technicalities. They're the difference between what you want, what you've written down, and what someone else is authorized to do to your body.
DNR, DNI, POLST, MOLST, POST, MOST, advance directives, and medical powers of attorney serve different purposes. Some direct emergency treatment. Others document broader wishes or give someone authority to speak for you. None works exactly the same way everywhere.
Medical Orders at the End of Life explains what these documents do, where their authority ends, which ones you need for the decisions you're making, and what happens when those decisions collide with medical rules, hospital policies, or the law.
It's the newest guide in the Parallel Deathcare Library, the growing collection of practical books from the Anarchist Death Project.
What's Inside
The book follows these documents from the kitchen table to the moment they're tested:
Why your wishes aren't the same as medical orders, and how an advance directive differs from an order an ambulance crew can act on.
What DNR, DNI, POLST, MOLST, POST, and MOST actually mean, and where each one's authority ends.
Which documents apply to different circumstances, whether you're healthy, seriously ill, living alone, relying on chosen family, or planning to die at home.
Getting the order: who can sign it, what to ask your doctor, and what to do when a doctor refuses.
What happens when someone calls 911, and what emergency workers are required or permitted to do.
Keeping your orders accessible and useful, changing your mind, and making sure older instructions don't interfere with newer decisions.
Who can speak for you, including partners, friends, chosen family, and relatives the law may recognize without asking you.
What to do when your wishes are ignored, both during an emergency and afterward.
The book concludes with an afterword titled No Final Permission.
Your Body, Your Decision
The book starts from a simple idea: your authority over your own body doesn't come from a hospital, a license, or a government form. It's yours.
That doesn't mean there's one right answer. One person wants every treatment available. Another refuses resuscitation but would welcome antibiotics for pneumonia. Someone else wants to stay at home with the people they trust. Accepting medical help isn't giving in, and refusing it isn't a badge of honor. What matters is that the choice belongs to the person whose body it is, and that the people around them know how to make it stick.
Along the way, the book keeps asking a question most of us never think to ask: says who? A rule might come from a law, a regulation, a genuine medical necessity, or simply the way a hospital prefers to do things. Those aren't the same, and knowing the difference can change what happens next.
What you want. What the document says. What the law recognizes. What the institution does.
Built on Real Research and Real Work
The research behind this book examines medical-order systems across all 50 states, the District of Columbia, and the five inhabited U.S. territories. It goes beyond identifying forms to investigate who can sign them, which orders emergency workers must recognize, how people can change or revoke their instructions, and what happens when a hospital, doctor, or family member challenges a decision.
The guide is written jointly by Fíona Vivienne, editor of our lovely Bacchus Editions, and High Noon Hills Natural Burial Grounds & Conservation Cemeteries. It brings together the extensive legal and medical research of the Anarchist Death Project with the practical experience of people working directly in deathcare.
That work gives Bacchus Editions an unusual foundation for publishing these guides. Rather than repeating general advice about getting one's affairs in order, the research follows the actual laws, documents, and medical procedures that determine what happens when someone becomes unable to speak for themselves. It also examines where institutions claim authority, where that authority has legal limits, and what people can do when their decisions are challenged.
This is a book to keep within reach. Bring it out when making arrangements, preparing for a medical appointment, helping someone you love, or trying to understand who will have the power to decide when you cannot speak.
End-of-Life Forms: The Paperwork of Dying
The Anarchist Death Project began with How to Bury an Anarchist and has grown into a library of practical deathcare guides, legal resources, and end-of-life forms. Its online section, The Paperwork of Dying, provides state-by-state forms and links to official sources, which can be updated as laws and requirements change.
Every copy of How to Bury an Anarchist includes a skeleton key to the complete online Project, including the Parallel Deathcare Library. But you do not have to buy a book to get access. Simply contact us and request a free access code. This knowledge belongs in everyone's hands, whether they purchase our books or not.
Explore the Anarchist Death Project, or write to us for your free access code.
Available Now
Medical Orders at the End of Life is a 140-page, perfect-bound book, available now from Bacchus Editions.
It grows out of How to Bury an Anarchist, the book that began the Anarchist Death Project, and joins the expanding Parallel Deathcare Library in putting practical deathcare knowledge into the hands of the people who need it.
No one becomes less their own because they are ill, unconscious, dependent, or dying.
Medical Orders at the End of Life: Available Now in the Bacchus Editions Bookshop