Do you have an advance directive? This is a question that you would most likely have to answer when checking in at a hospital or the Emergency Room. While many people think of this question as it relates to “end of life”, there are other several reasons why we have to consider having one.

Advance directives are not only for the elderly. Unexpected life situations can happen to anyone at any age. Having a legal, written document in place ensures that our medical care preferences are carried out in times of grief or crisis when we are unable to make our wishes known.

Advance directives are an important part of health care. This document allows us to make important decisions involving our own medical care and treatment. It helps guide our loved ones and healthcare professionals in making medical interventions that are in alignment with our wishes. It reduces confusion and disagreement while fostering respect for each of our own unique and individual approach about our own existence.   

An advance directive has two (2) parts:  

Living Will

A living will is a written document that gives specific instructions about any aspect of one’s health care. It serves its use especially at “end of life” situations, when a person becomes terminally ill or permanently unconscious. A living will determines the type of medical treatment a person would want or not want to receive in cases whereby he is unable to make the decisions and choices on his own. Treatments which can be covered under a living will include:

• Resuscitation measures;
• Dialysis treatments;
• Tube feedings;
• Mechanical ventilation;
• Comfort care;
• Organ and tissue donation;
• Donating your body for scientific reasons.

Durable Power of Attorney for Healthcare

Also known as a medical power of attorney, this document names another individual as agent to make health care decisions if one becomes incapable of making them. A person can also name a proxy if he wants someone else to make those decisions for him even if he is still capable.  Some of the decisions that an agent or proxy will have the right to are:

• Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or affect a physical or mental condition;
• Select or discharge health care providers and institutions;
• Approve or disapprove diagnostic tests, surgical procedures, and programs of medication;
• Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation (CPR);
• Donate organs or tissues, authorize an autopsy, and direct disposition of remains.

Before a medical power of attorney can take effect, a person’s physician must first certify that the patient is unable to make their own medical decisions. Durable power of attorney laws varies from state to state. Check your state laws and talk to your health care team for guidance.

Other related legal documents that do not fall under advance directive are:

POLST

POLST stands for Physician Orders for Life-Sustaining Treatment.  A POLST form contains a set of specific medical orders that address a person’s wishes in an emergency. However, it is not considered as an advance directive. This form is used and recognized in the state of California and is only available in some states.  

The POLST is signed by a qualified member of a person’s health care team such as a doctor, an emergency personnel like paramedics and EMTs (Emergency Medical Technicians). It is a one-page form that identifies how to proceed during emergency situations such as whether to use CPR (cardiopulmonary resuscitation), whether to go to a hospital in an emergency, be put on a breathing machine if necessary, or stay at a certain location (hospice or home) and be made comfortable.

DNR

A Do Not Resuscitate (DNR) order clarifies resuscitation treatment such as CPR and the use of AED (Automatic External Defibrillator) to revive and restart the heart as well as the use of life-sustaining devices such as breathing machines or ventilators.

Having a DNR order on hand means that if a person’s heart or breathing stop, nothing will be done to try to revive the individual named on the DNR order. A person signs this form, which gets added to his medical records. It is a legal document that limits the extent of medical measures that hospital staff need to take in situations involving a cardiac or respiratory arrest or both. Please note that a DNR order is only good while you are in the hospital.

Organ and Tissue Donation can be included as part of an advance directive. You can also carry an organ donation card which is provided by most states or add notations to your driver’s license.

Other Points to Remember:

• When writing your advance directive, take time to think about the kinds of treatments that you wish or do not want to receive if you get seriously hurt or ill. Share your questions or concerns with your doctor or nurse, your lawyer, your family member, or a friend.

• Advance directives can be changed, updated, and cancelled at any time in accordance with state law. Just fill out new forms to replace the old ones and make sure to inform your family, your doctor, and your health care agent about the change.

• Advance directives follow the regulations mandated by the state. Consulting an attorney when preparing your advance directive is a wise choice. Taking this into consideration, an individual who resides in multiple states may wish to have an advance directive in each state.

• Make sure your agent or health proxy has an updated copy of your advance directive.

• Make sure to provide a copy of your advance directive to your doctor and other medical care providers.   

Sources:

https://www.augustahealth.com/health-focused/what-are-advance-directives-and-why-are-they-important

https://www.uofmhealth.org/health-library/aa114595

https://www.cancer.org

California Hospital Association

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