Advanced Directives for Healthcare

Advanced directives for healthcare have been around for some time helping to direct the care of seriously ill individuals. These documents are also referred to as durable powers of attorney for healthcare or living wills.

One flaw, that is being addressed with a new tool, has been the ability in some cases for doctors, hospitals or family members to override an individual's wishes.

In your directive or living will, you appoint someone to make health care decisions for you when you are incapacitated and discuss how you would like to be cared for. Recently a new component has been added, the Physicians Order for Life Sustaining Treatment or POLST.

The POLST program is being discussed nationwide and rolled out on a state-by-state basis. Follow this link to see if your state has implemented a POLST program yet.

POLST takes the wishes expressed in advanced directives of all types and translates them into a “physicians order” that is signed by an individual and their doctor. The POLST, which is printed on a bright pink piece of paper for visibility, follows the patient as they move from home to hospital to skilled nursing and beyond.

A POLST may not be appropriate for healthy individuals.

The order usually comes into play when individuals are of an advanced age, have chronic conditions like dementia that substantially affect their quality of life or have a terminal condition.

In consultation with your doctor or other health care professional you will decide the answers to three key questions about care you may require in the future. Your doctor can describe scenarios when these type of decisions may come into play and help you think though what your choices will be. If you have been appointed as the health care agent for a family member with dementia, you can make decisions and sign a POLST on their behalf if they are no longer able to make their own health care decisions.

Here are the three questions:

  1. Do you want artificial nutrition if you cannot receive food by mouth?
  2. Do you want to receive cardio-pulmonary resuscitation if you stop breathing and your heart stops beating?
  3. Do you want to be put on a ventilator if you have trouble breathing or cannot breathe on your own?

The POLST protects the patient’s right to decide what type of treatment that they want. Once you have completed your advanced directives whether it includes a POLST at this time or not be sure to share your decisions with family and friends so they can support you.

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