Advance Directives 

Advance directive is the umbrella term for instructions regarding patient care. These are implemented if you are unable to make your wishes known. There are two types of advance directives: (1) the Directive to Physicians (“living will”) and (2) the Durable Power of Attorney for Health Care Decisions.

The Physician Orders for Life-Sustaining Treatment (POLST) form represents a way of summarizing an individual’s wishes regarding life-sustaining treatment. The form is intended for any individual with an advanced life-limiting illness and serves two major purposes:
  • it is portable from one care setting to another, and
  • it translates an individual’s wishes into actual physician orders.

Directive to Physicians

The Directive to Physicians is a legal document that specifies what types of medical treatments you desire in the event that you become incapacitated and are unable to make your wishes known. Health care directives enable people who do not want their lives artificially prolonged to make their wishes known.

A living will can be general or very specific. The living will goes into effect only if you have a terminal condition, as certified by your physician, in which life-sustaining treatment would only artificially prolong the process of dying. It also goes into effect if you are certified by two physicians to be in an irreversible coma or other permanently unconscious condition and there is no reasonable hope for your recovery. In either situation, the directive in your living will allows treatment to be withheld or withdrawn so that you may die naturally. If you are able to make your wishes known then you are still able to make decisions, which is not consistent with the advance directive.

You may direct whether you would want to be resuscitated. You also may direct whether you would want artificially provided nutrition (food) and hydration (water) stopped under these circumstances. The health care directive must be signed by you and by two witnesses who are not related to you and who will not inherit anything from you in the case of your death. You can change or revoke this directive at any time.

Durable Power of Attorney for Health Care Decisions

The Durable Power of Attorney for Health Care Decisions is a type of advance directive that specifies who would be the health care decision maker if you are unable to make your own decisions or are unable to make your wishes known. This form gives the appointed person authority to make medical decisions for you while you are medically incapacitated. A general power of attorney does not allow a person to make health care decisions; there must be specific reference to health care decisions in the power of attorney form.

Physician Orders for Life-Sustaining Treatment

Even if you have some form of advance directive, it is a good idea to have Physician Orders for Life-Sustaining Treatment (POLST) if you have a serious health condition. The POLST form translates your wishes, as expressed in your advance health care directive and/or durable power of attorney, into clear and specific medical orders. A POLST form can be obtained at your physician’s office.

The POLST form is a highly visible lime green medical order form that remains with you if you are moved between care settings, regardless of whether you are at home, in the hospital, or in a long-term care facility. If you live at home, it is recommended that you keep your original POLST on the refrigerator, where emergency responders can find it. If you live at a long-term care facility, your POLST will be kept in your chart.

The POLST form provides information about your specific medical conditions, including
  • your preferences regarding resuscitation,
  • your directives regarding the use of antibiotics, and
  • your desires regarding artificially administered fluids and nutrition. 
Use of a POLST form is entirely voluntary and is intended to help you and your physician discuss your specific wishes and develop plans that reflect them. The POLST will give physicians, nurses, health care facilities, and emergency personnel direction to enable them to honor your wishes regarding life-sustaining treatment. Comfort measures will always be employed, even if you have a POLST. Your POLST must be signed by a physician (or physician designee) in order to be followed by other health care professionals.

This information on advance directives and POLST comes from various sources, including the Center for Ethics in Health Care and the Washington State Medical Association.

For more information on advance directives, visit the American Hospital Association’s Put It in Writing Web site . Elements of the site include a wallet card, a brochure, a glossary, and an advance directives tool kit.

 For more information, call Home Health at 360-385-0610.