Many know that it is important to express your health care wishes for end-of-life care and medical emergencies, but you may be confused on the types of advance directives and their meaning.
Advance directives establish how you want to be cared for during hospitalizations and end-of-life situations if you become unable to make your own decisions. You can state whether you want life support and appoint a medical proxy who can make decisions for you, among other items.
“Death is the only common denominator everyone has,” says Mary Main, director of community relations at Juniper Village, a partner of Masonic Village Hospice. “Which is why end-of-life care is so important and has come so far.”
A living will provides a way for you to state your general treatment wishes during end-of-life situations such as a terminal illness or permanent unconsciousness. It regards decisions about wanting or not wanting treatments including dialysis, tube feedings or life support.
This legal document is filled out or dictated by you. The living will does not come into effect until at least two physicians confirm that you are unable to make medical decisions for yourself. Medical first responders do not look at living wills or other advance directives before providing life-saving treatment because they are not medical orders, such as a do-not-resuscitate (DNR) order or Physician Orders for Life-Sustaining Treatment (POLST).
Medical Power of Attorney
This is a legal document stating that someone else will have the authority to make medical decisions on your behalf. A medical power of attorney only starts applying when your physician certifies that you are unable to make your own medical decisions. You can designate your proxy in a living will or in a separate legal document.
Whomever you designate as your proxy for medical decisions should be a trusted friend or family member. Since there may be situations that you don’t outline in a living will, they will have to understand how you would make decisions and follow what they feel you would do.
Both living will and medical power of attorney directives do not need to be notarized but do require two witnesses to sign them to make them binding.
DNR orders work alongside advance directives to provide a complete outline for what care you want to receive if you’re unable to make medical decisions. A DNR order can be put into your medical file by your physician, at any time, upon request. This states that you do not want to receive cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. If a DNR is not on file, hospital staff and emergency first responders are required to try resuscitation.
A POLST form helps you describe your wishes for health care and serves as portable medical orders that outline whether you want to be taken to the hospital and receive life support, or to remain in place and be made as comfortable as possible in your home during a fatal medical emergency or during end-of-life care.
POLST forms are not considered advance directives themselves, but, like a DNR order, often work alongside them to provide a complete outline for what care you want to receive if you’re unable to make medical decisions. They are created by your physician, with your approval, and give specific medical orders should a medical emergency occur.
Like a DNR, a POLST is also a medical order, so first responders and hospital staff are required to take the order into account before providing any treatment. It is important to keep a copy of your DNR and/or POLST form with you and in your home so you or a loved one can direct first responders to review it before they treat you.
Regardless of what advance directives or medical orders you pursue, all states have their own laws surrounding them, so depending on where you live, it’s either required or recommended to discuss all future treatment plans with your doctor or lawyer. In addition, it’s just as important to keep family and close friends informed about medical decisions you make in legal documents.
Main reminds of the importance of talking with family about your end-of-life care decisions. “[End-of-life care] addresses your and your loved one’s fears, worries and anxieties,” she says.
Advance care planning is a service offered through Masonic Village Hospice, and staff are well prepared to help patients and their family accomplish their health care goals.