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It’s never too early – even though it may be a difficult conversation, many people have said they felt empowered after expressing their final wishes.
Planning for your future healthcare needs can be a challenging and confusing process. The many legal and medical forms can leave you uncertain of which one to complete. However stressful it is, deciding and completing these documents now can prevent a lot of pain, confusion, and stress in the future. Outlining your medical wishes and end-of-life care helps ensure your wishes are fulfilled and alleviates the challenges your family may suffer from making decisions for you.
Although the terminology may vary by state, there are:
A physician order for life-sustaining treatment (POLST) has different titles for each state. For example, in your state, it may be called a Medical Orders for Scope of Treatment or Portable Medical Orders. Regardless of its title, a POLST is a medical order that remains valid even outside the doctor’s office. This order is similar to a prescription for medications.
The POLST can include several things, such as:
The POLST form outlines to all healthcare providers what you would like to happen if you were in a medical emergency. These choices can include:
Although this may sound like other plans of care, like a Do Not Resuscitate, the POLST gives you specific direction over the types of healthcare treatments and for how long. The POLST is especially useful for those who are seriously ill.
A Do Not Resuscitate (DNR) is a medical order written by a physician. This order informs healthcare providers not to perform cardiopulmonary resuscitation (CPR). CPR is typically performed when your heart stops or you stop breathing. DNRs can also include a Do Not Intubate (DNI) order. A DNI informs healthcare providers you do not wish to be placed on ventilation for breathing.
A DNR is specific to CPR and does not include information regarding continued life-sustaining methods. CPR can involve:
Although it is recommended to have an advance directive or living will, you do not need either to have a DNR.
Choosing a DNR can be a very difficult decision, so it is important to talk about it with your doctor, who can help you understand any pros and cons of choosing a DNR. Once you have made the decision, you inform your doctor, who then writes the medical order in your medical record.
A DNR can be part of a hospice care plan. Palliative care and hospice focus on treating your symptoms in order to achieve and maintain an acceptable level of comfort. Hospice care is neither designed to treat your disease nor hasten its progression; rather, hospice is meant to make the remainder of your life comfortable. If admitted to hospice care, your hospice care team can assist you with these types of decisions. Additionally, your hospice care medical social worker can assist you in discussing your wishes with your loved ones.
A power of attorney (POA) is a legalized document that gives permission to someone of your choosing to act on your behalf, should you be deemed unable to do so for yourself. In some states, this can be also be referred to as a durable power of attorney.
In the POA, you will identify at least one person whom you trust to make decisions for you. POA forms are available online, but you might want an attorney to assist you in creating your POA. In some cases, if someone is not identified in a POA, a court will assign someone to be your guardian.
In your POA, you can give permission to different people for different roles, such as:
The financial POA is allowed access to your finances to pay your bills or sell your property. The medical POA, whether you select them or they are assigned, will be able to make medical decisions for you if you are incapacitated for any reason. A combined POA can allow you to control multiple aspects, such as both financial and medical decisions.
A POA does have some risk involved, as you are giving power to someone else. Unfortunately, some may abuse this power. Abuse of a POA can be seen as:
Be sure to select a POA that can be trusted and considers your best interests as top priority.
A living will is also a written legal document. A living will outlines your preferences for medical care. A living will provides instructions on how you would like to be cared for if you are unable to make those decisions for yourself. Your living will should address several of your end-of-life decisions such as your interest in:
An advance directive informs doctors and caregivers of your healthcare choices and can help guide them when you are:
Each state has different requirements and forms to make your advance directive legal. You may consider consulting with an attorney to assist you in creating this document; however, it is not necessary. For many states, it is sufficient to have yourself and a witness sign, whereas in others, you may need to have the document notarized.
When completing your advance directive, it is a good idea to discuss it with your doctor so they can ensure the form is filled out correctly. An advance directive can be changed. Sometimes you may want to change your medical preferences due to:
If you are under the care of our hospice team, your hospice social worker can be helpful throughout the process of making these types of decisions. Your hospice social worker can also help you and your family create these documents or get you connected with local attorneys.
If you are not already connected to a hospice care team, start with your primary care physician (PCP). Your PCP can help get you connected to resources in your area who can help with these types of documents.
Regardless of which documents you choose, always: