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Alabama Estate Planning: Understanding Do Not Intubate Orders

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 Stone & Britt, LLC, our estate planning attorneys in Alabama 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 attorneys based in Wetumpka today at 334-517-6520 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 to help someone breathe when they cannot do so on their own. A tube is inserted through a person's nose or mouth into their trachea to keep their airway open. This tube is then attached to a ventilator which pumps air into it. 

Intubation is often performed in emergencies, such as when a patient is in cardiac arrest or has low oxygen levels or a traumatic neck, abdomen, or chest injury. It's also done routinely before surgery due to the effects of general anesthesia. 

Types of Intubation

Based on the location of the tubing, three main types of intubation exist.

  1. Nasogastric intubation, which involves the tube passing through the nose and into the stomach to remove air or feed/medicate a person;
  2. Endotracheal intubation, which involves a tube passing through the nose or mouth into the trachea to assist a person's breathing while under anesthesia or in a distressed airway; and
  3. Fiber-optic intubation, which involves the tube passing through the throat to examine the throat or assist with endotracheal intubation.

The intubation process varies based on its purpose and whether it is an emergency situation or a planned operation.

Risks of Intubation

Like any medical procedure, intubation carries risks that you should know. These risks are more likely to occur in an emergency situation and include:

  • Incorrect tube placement, where the tube enters the esophagus or lung bronchi instead of the trachea, leading to serious complications including a collapsed lung or even death
  • Infections, like pneumonia
  • Injuries to the mouth, teeth, or vocal cords
  • Trauma to chest cavity tissues, which can also cause a collapsed lung

Generally speaking, there is a small level of risk associated with intubation, especially when compared to its potentially life-saving effects. 

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.

  1. 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.
  2. 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.
  3. 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.

How DNIs Work in Alabama

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

The process for obtaining a DNI is state-specific. Typically, a DNI is a form completed by the individual (or their healthcare agent) and their doctor. The form or a note about it is then placed on the individual's digital and paper medical records, alerting medical professionals that they do not want to be intubated. 

When you are in need of hospitalization, you can sign a DNI. When not in need of hospitalization, you can proactively prepare one as part of your estate plan. The most common ways are to do so via any one of the following:

  • Advanced directives, which are legal documents explaining your wishes on medical care in the event you are incapacitated
  • Living will, which is another legal document outlining the medical treatments, procedures, and medications you want or do not want in life-saving situations when you are incapacitated
  • Durable power of attorney for healthcare, which is another legal document granting someone the ability to make decisions for you if you are incapacitated – the appointed person can express your preferences and enact a DNI order

Any one of the above can become part of your estate plan. The one you choose may be dictated by your jurisdiction's requirements. That is why it is important to speak to an estate planning attorney in Alabama to make sure your estate plan, including any DNI order, is adequately drafted and executed.


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 Alabama?

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 Alabama

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 Wetumpka 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 Stone & Britt, LLC, our estate planning attorneys in Alabama 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 334-517-6520 to schedule a consultation.

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