Advance DirectivesI may lose some of you with that headline but be assured that this is a relevant and important topic for you to explore regardless of your age, health status or income. We probably all know someone who had an accident that caught family and friends unprepared for the aftermath. Or a family member may have been diagnosed with an illness that would end their life prematurely. At those times, when a crisis arises there are other important matters that need to be addressed and our thinking isn’t always clear or focused. Get that plan laid out so that everyone is on the same page, no one is caught off guard, and decisions can be made with the relevant parties’ input and best interests assessed and addressed.

 

Advance planning avoids unnecessary suffering, confusion, disagreement and disappointment. The topic of this missive addresses health care decisions only, not financial issues or property. Those should also be addressed prior to an unexpected event but involve different documents and are best handled with the assistance of an attorney and/or accountant based on individual circumstances.

 

Advance Directives for health care may include all/or some of the following:

  • Medical or Health Care Power of Attorney (aka Health Care Proxy)
  • Living Will
  • Do Not Resuscitate Order (DNR)
  • Do Not Intubate Order (DNI)
  • POLST (Provider Orders for Life-Sustaining Treatment) may also be known as MOLST (Medical Orders for Life-Sustaining Treatment)

Some things to keep in mind about each of the documents listed above:

  • States may have different requirements and different documents so be sure you are aware of what is needed in your state
  • You may change your documents at any time but be sure you are using the most up to date form and destroy any old copies. Make sure to replace the old documents with the new ones for anyone who had copies previously
  • Review your documents periodically and update them if your wishes or circumstances have changed

Now let’s dig into the purpose of each document and some of the reasons for having them.

Medical or Health Care Power of Attorney (aka Proxy)

The purpose of this document is to name a person, or persons, who will make decisions for you if you are unable to do so for yourself. Sometimes situations arise where a decision has to be made that may not be spelled out in your other documents.

This person, or persons, would be responsible for making these decisions. Because of that you need to choose carefully and have discussions. Questions to ask yourself before naming this person(s) are: who do you trust, are they in agreement with your decisions, are they willing to take on the role, and have you discussed with them  your wishes? There may be state rules or requirements as to who can engage in this role.

Spouses, family members, friends, or acquaintances may fill this role. Your medical provider or another member of your health care team cannot fill this role for you.

Living Will

A Living Will lays out the medical treatments you desire, or do not want, to keep you alive. There are many decisions to be made in putting this document together so you should have a detailed conversation with your health care team before making decisions.

This is another reason to get this document in place before an accident or illness occurs. Remember, as long as you are cognitively able to make decisions you may change the contents, but if you are not able to make decisions how do you want your care to be handled? A health care provider can lay out the scenarios for you and answer your questions.

Do Not Resuscitate (DNR) and Do Not Intubate (DNI)

These items address the specifics in their title DNR and DNI items may be addressed in your Living Will, but it doesn’t hurt to have them specifically addressed and provided at the time of hospital admission or even admission to a rehabilitation facility after orthopedic or other surgeries.

POLST or MOLST

Usually, a POLST or MOLST is not required unless you have been diagnosed with a chronic and serious illness with a shortened life expectancy. Your medical provider will have this form and should discuss it with you at the time of such diagnosis or admission to home care or hospice services. It should include the items in  your Living Will as well as the name of your Medical or Health Care Power of Attorney. This document is usually posted on the front of your chart in the hospital or clinic where you regularly receive your health care. It may also be posted near your bedside if you are hospitalized. If you are being cared for at home and have one of these forms, it should be in a visible location so that your wishes are displayed and who to contact for decision making.

In closing, a few things to remember:

  • You can cancel or change these documents at any time so long as you can make decisions
  • Each state may have separate documents with alternative names so be sure you are using the correct documents and have met the requirements
  • Some states may require witnesses or notarization so be aware of that to be sure you are covered
  • Speak with family members, your health care team, and any others who may be in a position to weigh in on decision making if you are incapacitated so that there is no confusion, conflict, or disagreement
  • These documents are so that your wishes can be honored
  • Review your documents periodically and make changes as your situations change
  • Live your life fully and to the best you can with the assurance that you have made arrangements for the care you desire and deserve in case of an unexpected emergency or change in status.

For more information and state specific requirements you may be interested in following up with some of the following:

  • AARP
  • American Bar Association
  • CDC (Center for Disease Control)
  • Mayo Clinic
  • National Home Care Association
  • National Hospice & Palliative Care Organization
  • Your state specific Secretary of State