Advanced Illness and Life Planning
Advanced Illness and Life Planning

Health Care Document Information

What is an Advance Directive?


An Advance Directive is legal document that names a decision-maker and outlines your general medical preferences. It must be signed by you and either witnesses or a notary. It is not signed by a doctor.  There are 2 sections:


1) Health Care Power of Attorney


This section is the minimum to fill out for a complete advance directive. Here is where you name a health care power of attorney (HCPOA) who would be contacted by doctors if you had a medical condition that prevented you from being able to communicate with your medical team or make your own decisions. This is different than a financial power of attorney who only handles matters of finances and property. Some might name a spouse, parent, or child but you can also name a friend or signficiant other. Officially naming a HCPOA is most important when your chosen person is not in your immediate family or if your family has strong differing opinions about approaches to medical care.


Before documenting your HCPOA, you should contact them to ask if they would be willing to step into this role if needed. If they agree, you should keep them updated on your wishes as they may change over time. Remember, the key to your HCPOA being an effective advocate for you is the conversations you have with them about what care you want and don't want.


2) Living Will


This section is where you can indicate any other health care wishes. It is optional, but can be very helpful guidance to medical teams. You might indicate a general approach to your health care, such as wanting to focus on comfort if you have a terminal or irreversible condition. Others get very specific about their wishes around hydration, artificial nutrition, feeding tubes, ventilators/ life support, CPR, or organ donation. If your religious beliefs impact your medical decisions, this is the place to explain in detail.


Completing this section with a physician can ensure you have an accurate understanding of complex medical treatments that many people only see portrated in TV shows and movies.




Helpful facts about Advance Directives:


-- You cannot complete one if you do not have mental capacity to make decisions

-- Anyone over 18 is encouraged to have one regardless of health condition

-- Your witnesses cannot be the same as your HCPOAs

-- They do not expire

-- You can update or change your document at any time

-- It is not the same thing as "a DNR" (see POLST below)



What is a POLST (Physician Order for Life Sustaining Treatment) ?


Different than an Advance Directive, a POLST (also sometimes called "a DNR") is a medical document instead of a legal document. It gets signed by either you or your decision-maker/HCPOA and a physician, nurse practitioner, or physician assistant. It is a powerful document that acts as an active MD/NP/PA order and must be honored by health care providers or EMTs who have access to it.


The POLST is generally recommended for people who are of advanced age and/or have life-limiting illnesses.  It specifically addresses the issue of whether or not to perform CPR if someone is in cardiopulmonary arrest (heart and breathing stops).  If a patient and doctor decide together that performing CPR would cause the patient excessive suffering with minimal chance of returning to acceptable quality of life, they might mark "Do Not Attempt Resuscitation" or "DNR".  


Decision around whether or not to perform CPR (Part A) is the most important and only required section of this document. The other sections to further clarify your wishes are optional.


If you have a POLST completed and change your mind, you can simply complete a new POLST with a provider and make sure your medical teams have an updated version.


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© Erin Reeve, MD