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Advance Directives and the POLST

Advance Directives and the POLST

Most of us spend a lot of time planning. From vacations to our financial future, careful versus haphazard planning can make the difference between a botched vacation and insufficient funds for a timely retirement. In the healthcare world, poor end-of-life care planning may result in pain and suffering for you and your loved ones.  

For many people, it is difficult to talk about death. Imagining the world without you or your loved ones in it can produce indescribably painful thoughts and emotions. But death is inevitable and having end-of-life care conversations has never been more important in an ever-changing healthcare world. As healthcare providers, we want to make sure you have this critically important information about advance directives and the Physician Orders for Life-Sustaining Treatment, or POLST. You can use these two documents to help facilitate end-of-life care discussions.

You may hear the term “Advance Directives” during discussions about healthcare or long-term care. But what are they? Advance healthcare directives include two types of legally recognized documents called a living will and a healthcare power of attorney. These documents enable a competent adult, who is 18 years of age or older, or an emancipated minor, to plan for and communicate his/her end-of-life care decisions in the event that he/she is unable to communicate them when needed. You do not need a lawyer to fill out advance directives, which essentially protect your right to decide what types of medical care you would or would not desire, in the event you lose the ability to make decisions yourself.

This link, http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3277, provides state-specific information and step-by-step instructions for completing the advance directives.

Advance Directives include a Living Will and Healthcare Power of Attorney.

Key Points on Living Will

  • A Living Will provides instruction for future health care treatment and inpatient hospital treatment decisions at the end of life.
  • It does NOT guide emergency medical services. Ambulance and hospital emergency department personnel are required to provide cardiopulmonary resuscitation (CPR) unless they are given a separate directive that states otherwise.
  • Your living will not guide medical decision-making until two physicians have certified that:
  • You are unable to make medical decisions.
  • You are in the medical condition specified in the state’s living will (such as “terminal illness” or “permanent unconsciousness”).
  • Other requirements may apply based on state-dependent policies.

Key Points on Healthcare Power of Attorney

  • A Healthcare Power of Attorney allows you to appoint a trusted representative to make medical decisions on your behalf.
  • You may limit your representative’s ability in the document, but this may also make it difficult for your representative to make decisions for you as your state of health changes.
  • Your appointed representative cannot make decisions on your behalf until your physician has concluded that you are unable to make your own medical decisions or you specify that you would like them to begin making decisions for you immediately.
  • Your agent will have the right to (unless you designate otherwise):
  • Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition
  • Selector discharge health care providers and institutions
  • Approve or disapprove diagnostic tests, surgical procedures, and medication
  • Direct the provision, withholding or withdrawal of artificial nutrition and hydration and all other forms of healthcare, including cardiopulmonary resuscitation
  • Make anatomical gifts, authorize an autopsy, and direct the disposition of your remains.

Here are some other Advance Directive Facts you may want to know:

  • They can be state specific and they never expire.
  • They become legally valid once you sign them in front of the required witnesses.
  • They should be reviewed periodically and updated if needed.
  • If you complete a new advance directive, the previous one will be invalidated.
  • Be sure to talk with your family, friends, and physicians about your advance directive.
  • Ensure the person you appoint to make decisions on your behalf understands your wishes and what you consider to be an acceptable “quality of life.”
  • Once the form is completed and signed, give copies to your appointed representative, alternate agents, your family, friends, health care providers and/or faith leaders so that the form is available in the event of an emergency.
  • If you enter a nursing home or hospital, have photocopies of the document available in your medical records.
  • You may also file your advance directive in California’s Advance Directive Registry: http://www.sos.ca.gov/registries/advance-health-care-directive-registry/

Physician Orders for Life-Sustaining Treatment

Another type of critically important healthcare document is the “Physician Orders for Life-Sustaining Treatment,” or POLST. The Coalition for Compassionate Care of California describes the POLST as:

“A medical order signed by both a patient and physician, nurse practitioner or physician assistant that specifies the types of medical treatment a patient wishes to receive toward the end of life. POLST is also a tool that encourages conversation between providers and patients about their end-of-life treatment options and helps patients make more informed decisions and communicate their wishes clearly. As a result, POLST can prevent unwanted treatment, reduce patient and family suffering, and help ensure patient wishes are followed.”

It is important for you to understand the difference between Advance Directives and POLST.

  • Advance directives provide guidance for future treatment wishes and to appoint a legal healthcare representative, or someone to speak on your behalf if you are unable to speak for yourself. It is recommended for all adults, regardless of health status, to plan for possible future health crises.
  • A POLST is designed for people who are in the last years of their life or are seriously ill. If this applies to you, schedule a visit with your primary care provider to discuss what POLST choices would be most appropriate for you.
  • If you are relatively healthy, you may only need an advance directive.
  • If you have a serious health condition, you may want both advance directives and a POLST. You must ensure that your treatment wishes are consistent with both documents to avoid any confusion regarding treatment.

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