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Advance Directives: A basic explanation of the three types of Advance Directives:
Designating a Health Care Proxy/Agent or Surrogate Decision-maker
Most states have laws that specify the requirements for authorizing another person to make medical decisions on your behalf. This may include the specific form or language to be used in the actual document. This type of advance directive allows you to designate a person of your choosing to make healthcare decisions on your behalf in the event that you are unconscious, cognitively impaired or unable to communicate your wishes due to injury or illness. These discussions and decisions can be difficult, but it is essential that you discuss your preferences openly and honestly in advance of completing the forms. Copies of the completed form should be shared with your doctor, appointed proxy, other family members and your local hospital (if you have received medical care) or other health care providers (SNFs, Home Care, specialists, etc), as appropriate.
Most proxy and surrogate forms allow you to specify specific wishes & preferences to guide your designated person, but they are free to use their own judgment to decide what is in your best interest. A copy of this document must be produced and given to a health care provider (doctor, nurse, EMT, ER staff, etc…). The AMA recommends that you keep a Wallet Card with the name and phone number of your designated person so emergency personnel easily and quickly contact them on your behalf in an emergency situation.
AARP - Advance Directive Forms by State
AMA - Advance Directive Wallet Card
Living Will or Durable Power of Attorney
Both state and federal laws govern the requirements for Living Wills or Durable Powers of Attorney. Despite different names, these legal documents carry the weight of law when they are properly executed and duly notarized.
A Living Will specifies & authorizes certain actions designated by an individual related to the individual and his/her property. A Durable Power of Attorney grants another person the legal authority to make decisions on behalf of an individual relative to two aspects of authorized decision-making: Actions and authorizations related to (1) the Person and/or (2) the Property of the individual named in the document. The powers authorized may be specific or all-encompassing, based on the wishes of the individual executing the document. Copies may be shared with all parties involved, your attorney and other family members, as appropriate.
Medical/Physician Order for Life-Sustaining Treatment (MOLST / POLST)
This is a Physician Order specifying a patient’s personal preferences related to end-of-life care. Most states require that your doctor complete a specific state form (sometimes states even specify the color paper the form must be printed on) for the MD Order to be valid. You will need to have an in depth discussion about your wishes and preferences with your doctor. Be sure to review your state’s POLST form in advance and write down your questions before you schedule a meeting to discuss this with your doctor. These are important decisions. Take whatever time you need to get answers to your questions, understand your options and make informed choices about your care.
Physician Orders apply to medical care delivered by a licensed health care provider (hospital, nursing home or rehab center, home health agency, dialysis or treatment center, clinic, ambulatory surgery center, etc) and will direct the care provided by your clinical team (doctors, nurse practitioners, nurses, aides, therapists, social workers, pharmacists, dietitians, etc). The original POLST remains with the patient when transferred from one level of care to another. Copies may be distributed to your doctor and trusted family members but only the original POLST will be accepted to govern the provision of care and services.
Most POLST forms are very specific and include directions or instructions on critical medical decisions, including but not limited to: CPR (Cardio-Pulmonary Resuscitation), DNR/DNI (Do Not Resuscitate/Do Not Intubate) Orders, DNH (Do Not Hospitalize) Orders, Artificial Nutrition and Hydration, NPO (Nothing By Mouth) Orders, Gastro or Naso-gastro Tube Insertion, IV Therapy, Pain Management, Comfort Measures, Antibiotic Therapy, Participation in Research and Organ Donation. Other instructions may be included. You can find a link to your state’s POLST form below:
Everplans: State-by-State POLST Forms
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