The term advance directive refers to a written expression of treatment preferences prepared in advance of an event. They also may designate a surrogate decision maker in the event that you should become unable to make medical decisions on your own behalf. Advance directives generally fall into three categories: living will, power of attorney, and health care proxy. A POLST is also a type of advance directive and a more specific expression of your living will.
Living Will: This is the legal document that specifies what types of medical treatments you desire in the event that you become incapacitated. Health care directives allow people who clearly do not want their lives artificially prolonged to make their wishes known. If you do not have an advance directive and cannot speak for yourself, life-sustaining treatment will be administered.
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 In either situation, the directive in your living will allows treatment to be withheld or withdrawn so that you may die naturally.
You may direct whether or not 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: This type of advance directive is a legal document that conveys power of attorney to another in the event you are in an incapacitated medical condition. It gives your appointed person authority to make medical decisions for you while you are medically incapacitated.
Physician Orders for Life-Sustaining Treatment (POLST): Even if you have some form of advance directive (living will), it is a good idea to have a 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 brightly colored, lime green (for visibility) 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:
- Preferences regarding resuscitation;
- Directives regarding the use of antibiotics, and
- 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 followed, even if you have a POLST. Your POLST must be signed by a physician (or physician designee) in order for it to be followed by other health care professionals.
The above information on advance directives and POLST is from various sources, including: the Washington State Medical Association, the Center for Ethics in Healthcare, and the Washington State Medical Association.
For more information on advance directives, visit the American Hospital Association’s Web site, Put It in Writing, at www.putitinwriting.org . Elements of the site include a wallet card, a brochure, a glossary, and an advance directives toolkit.
Mark Cherniack, a social worker with Jefferson Healthcare, is available to speak to your group or organization on advance directives. For more information, call 360-385-0610.