Have you ever thought about who would make medical decisions for you if you were unable to communicate? While it's not something we like to dwell on, planning for future healthcare needs is a responsible and loving act for ourselves and our families. Advance directives are legal documents that allow you to express your wishes regarding medical treatment in the event you become incapacitated. Without them, your loved ones could face difficult and emotionally draining decisions, unsure of what you would have wanted. Having advance directives in place ensures your autonomy and reduces the burden on your family during a challenging time.
Understanding the different types of advance directives is crucial to ensuring your healthcare wishes are honored. These documents offer a structured way to communicate your preferences regarding life-sustaining treatment, pain management, and other medical interventions. By taking the time to create these documents, you're empowering yourself and those closest to you, providing clarity and peace of mind when it matters most. Knowing the specifics of each type allows you to tailor your plans to your individual needs and values.
What are the 3 types of advance directives?
What are the specific differences between a living will, durable power of attorney for healthcare, and POLST?
A living will, durable power of attorney for healthcare (DPOA-H), and Physician Orders for Life-Sustaining Treatment (POLST) are all advance directives, but they differ significantly in their scope and application: a living will outlines your wishes regarding specific medical treatments in the future, effective only when you are incapacitated; a DPOA-H appoints a healthcare agent to make medical decisions on your behalf when you're unable to do so, covering a broader range of healthcare choices; and a POLST translates your wishes into actionable medical orders for healthcare professionals, particularly concerning end-of-life care and emergency situations, reflecting current medical condition and preferences.
A living will is a written document that expresses your preferences for medical treatment should you become unable to communicate them. It typically addresses specific scenarios, such as refusing life-sustaining treatment, artificial nutrition, or hydration when facing a terminal illness or irreversible coma. It focuses on *what* treatments you want or don't want. The effectiveness of a living will hinges on the clarity of its instructions and the accuracy with which it reflects your current values, as it only comes into play when you lack the capacity to make decisions. A durable power of attorney for healthcare (DPOA-H), sometimes called a healthcare proxy, designates a trusted individual as your healthcare agent. This person is authorized to make medical decisions on your behalf when you are unable to do so yourself. Unlike a living will, which specifies treatment preferences, a DPOA-H grants authority to someone to interpret your wishes and make decisions based on your best interests, potentially covering situations not explicitly addressed in a living will. It focuses on *who* will make decisions for you. The agent is expected to make informed decisions consistent with your values and prior expressed wishes. Physician Orders for Life-Sustaining Treatment (POLST), also known as MOLST or MOST in some states, are medical orders signed by a physician or authorized healthcare provider based on your expressed wishes. POLST forms are designed to be readily accessible to healthcare professionals and provide clear instructions regarding specific medical interventions, such as CPR, levels of medical intervention, artificial nutrition, and antibiotics. Unlike living wills and DPOAs, which are broader planning documents, POLST forms are intended for individuals with serious illnesses or frailty, translating their preferences into actionable medical orders. POLSTs are especially useful in emergency situations or when transferring between healthcare settings.If I have a living will, do I still need a durable power of attorney for healthcare?
Yes, you likely still need a durable power of attorney for healthcare, even with a living will. While a living will outlines your wishes regarding specific medical treatments in end-of-life scenarios, it may not cover all possible health situations. A healthcare power of attorney allows you to appoint someone you trust to make medical decisions on your behalf when you are unable to do so, addressing situations not covered in your living will and providing flexibility in unforeseen circumstances.
A living will, also known as an advance directive, is a legal document that specifies your preferences for medical care if you become incapacitated and unable to communicate your wishes. It typically addresses end-of-life decisions, such as the use of life-sustaining treatments like mechanical ventilation or artificial nutrition. However, it might not cover unexpected illnesses or injuries that require immediate medical attention but aren't necessarily terminal. For example, a living will usually does not cover temporary loss of consciousness from an accident or sudden, but curable, illness. A durable power of attorney for healthcare complements a living will by designating a healthcare agent, someone you trust to make medical decisions for you when you can't. This person can interpret your wishes, make decisions in situations not covered by your living will, and advocate for your best interests based on their knowledge of your values and preferences. Having both documents ensures that your wishes are respected in a wider range of medical situations, providing comprehensive guidance for healthcare providers and your loved ones. Advance directives are crucial tools in ensuring your healthcare wishes are respected, but it is also important to communicate with your designated healthcare agent about your preferences and beliefs regarding medical treatments. Also, all documents related to your healthcare, including your living will, and durable power of attorney for healthcare, need to be accessible to both your healthcare agent and your medical providers.How does a POLST differ from a living will in terms of medical orders?
A POLST (Physician Orders for Life-Sustaining Treatment) translates a patient's wishes regarding life-sustaining treatment into actionable medical orders that must be followed by healthcare professionals, whereas a living will is a document outlining general preferences for medical care and is not itself a direct medical order. In essence, the POLST is a doctor's order; the living will is a statement of patient wishes.
The key distinction lies in the level of direct applicability. A living will (or advance directive) expresses a person's general wishes regarding medical treatment if they become unable to make decisions for themselves. It outlines scenarios and preferred treatments or non-treatments, such as the use of ventilators, feeding tubes, or resuscitation. However, it is *not* a set of medical orders. Healthcare providers must interpret the living will and translate its intentions into specific medical actions. This interpretation can sometimes be subjective and lead to delays, especially in emergency situations. A POLST, on the other hand, is a standardized, portable medical order form specifically designed for individuals with serious illness or frailty. It directly states medical orders regarding treatments like CPR, intubation, antibiotics, and artificial nutrition. Because it is a physician's order, signed by both the patient (or their legal representative) and a physician (or other authorized healthcare professional like a nurse practitioner or physician assistant), it must be followed by all healthcare personnel. The POLST ensures that the patient's wishes are immediately respected across different healthcare settings (hospital, nursing home, home). It bridges the gap between patient wishes and actual medical intervention, particularly during emergencies.What happens if the three types of advance directives contradict each other?
When advance directives conflict, the document that most specifically addresses the current medical situation and reflects the most recent expression of the person's wishes generally takes precedence. However, navigating these contradictions can be complex and often requires careful legal and ethical consideration, potentially involving the courts.
The hierarchy amongst advance directives, when a conflict arises, is not always explicitly defined by law and can vary by jurisdiction. Generally, a durable power of attorney for healthcare (also known as a healthcare proxy) allows a designated agent to make medical decisions on the principal's behalf. If a living will or Physician Orders for Life-Sustaining Treatment (POLST) form directly contradicts a decision the agent believes is in the principal's best interest (or aligned with their known values), a legal and ethical dilemma emerges. Courts may then be petitioned to interpret the documents and determine the patient's true intent. To mitigate the risk of conflicting directives, it's crucial to ensure all documents are consistent and reflect the individual's current wishes. Regular review and updates are recommended, especially after significant life events or changes in health status. Clear communication with both the designated healthcare agent and the physician about the content of all advance directives is vital. Ideally, these discussions should be documented and included as part of the individual's medical record.Who can witness or notarize these 3 types of advance directives?
Witness and notarization requirements for advance directives vary significantly by state. Generally, a Living Will and Durable Power of Attorney for Healthcare (DPOAH) typically require two adult witnesses who are not related to you, not your healthcare providers, and not directly involved in your care. Some states allow notarization as an alternative to witnesses, or may require it in specific circumstances. A POLST (Physician Orders for Life-Sustaining Treatment) form, being a medical order, does not require witness signatures or notarization, but must be signed by both the patient (or their legal representative) and a physician, advanced practice nurse, or physician assistant.
The specific regulations regarding who can act as a witness are crucial to follow because failure to comply can invalidate your advance directive. Many states prohibit individuals who are beneficiaries of your will or estate from acting as witnesses. Additionally, anyone who stands to directly benefit financially or otherwise from your death may be disqualified. The best approach is to consult with an attorney or elder law specialist in your state to ensure compliance with local laws. They can advise you on acceptable witnesses, notarization procedures, and any specific phrasing required to make your documents legally sound. It is also important to note the role of healthcare professionals in advance directives. While they cannot act as witnesses, they play a crucial role in discussing your wishes, answering questions, and ultimately, honoring your directives. Open communication with your physician is vital to ensure your healthcare decisions are understood and respected. In the case of a POLST form, physician involvement is paramount since they must sign the order. POLST forms are specifically designed to be easily accessible to emergency medical personnel and other healthcare providers, ensuring your end-of-life wishes are honored across different care settings.Can I modify or revoke any of these three types of advance directives?
Yes, you can modify or revoke any of the three main types of advance directives—a living will, a durable power of attorney for healthcare (also known as a healthcare proxy), and Physician Orders for Life-Sustaining Treatment (POLST) forms—at any time, as long as you have the capacity to make decisions.
The ability to change your mind is a fundamental aspect of advance care planning. Your wishes may evolve over time due to changes in your health, personal values, or understanding of medical treatments. Revocation typically involves clearly communicating your intent to revoke the document. For a living will or durable power of attorney, this can often be done by destroying the document, providing written notice to your healthcare agent (if you have one), and informing your physician. A POLST form, being a medical order, needs to be explicitly voided or replaced with a new one by a healthcare professional, often with your direction. Remember that it’s crucial to communicate any changes to your advance directives to your healthcare providers, your appointed healthcare agent (if applicable), and your family members. This ensures that everyone is aware of your current wishes and that those wishes are respected if you become unable to speak for yourself. It is also a good idea to document the revocation in your medical records to avoid confusion.Where can I find the forms to create these three types of advance directives in my state?
You can typically find the forms needed to create a living will, durable power of attorney for healthcare, and POLST (Physician Orders for Life-Sustaining Treatment) form through your state's official government website (often the Department of Health or Attorney General), local hospitals and healthcare providers, elder law attorneys, and organizations specializing in advance care planning like the National Hospice and Palliative Care Organization.
State government websites are usually the best place to start. Look for sections related to healthcare, aging, or legal affairs. They often provide downloadable forms that comply with your state's specific laws. Hospitals and healthcare systems often have social workers or patient advocates who can provide the necessary forms and guidance on completing them. These resources are especially helpful as they can explain medical terminology and ensure you understand the implications of your decisions.
Elder law attorneys are legal professionals who specialize in issues affecting seniors, including estate planning and advance directives. They can provide customized legal advice and ensure that your advance directives are legally sound and reflect your wishes. For the POLST form, which is a medical order, it generally needs to be completed in consultation with a physician or other qualified healthcare professional who can assess your current health status and discuss appropriate treatment options. Not all states use the term "POLST"; some use similar acronyms like MOLST (Medical Orders for Life-Sustaining Treatment) or COLST (Clinician Orders for Life-Sustaining Treatment).
So, there you have it – a quick look at the three main types of advance directives. Hopefully, this has cleared things up a bit! Thanks for stopping by, and feel free to pop back anytime you have more questions about healthcare planning. We're always happy to help!