Advance Directive & POLST

We offer the guidance below to help you take the first step

All adults should have an Advance Directive. The purpose of the Advance Directive is twofold:

  1. To designate a healthcare representative who will make decisions about your care when you can’t, and
  2. To give instructions to your representative regarding your wishes in various circumstances.

Please note that while an Advance Directive is recommended, it is not required in order to enroll in hospice.

POLST forms address key issues relating to emergency or acute treatment:

  1. Whether you would want to be resuscitated with CPR if you are not breathing and have no pulse;
  2. If you are breathing and have a pulse, but are not able to communicate how much treatment you want: comfort, limited or full.

This information is specifically intended for Emergency Medical Technicians arriving at your home after a 911 call, or hospital staff. EMTs cannot be guided by what is in your Advance Directive – only by your POLST form. If you are in frail health and likely to have an emergency situation, it is a good idea not only to fill out a POLST but to have it in a place that is readily accessible, like your fridge. There is an online POLST registry that EMTs check, but this takes time and may not be 100% reliable.

Please note that while a POLST is recommended, it is not required in order to enroll in hospice.

The document is legal until you revoke or change it. Importantly, your representative can only make decisions on your behalf while you are incapacitated – not while you are able to make your own decisions.

Often people think of a family member first. While this may be the right choice, there are circumstances where it could be better to choose a close friend – such as:

  • Your family member lives some distance away (time zone or travel time issues). Particularly in the hospital setting, decisions are made quickly and real time input may be critical.
  • Your family member does not fully agree with the decisions you have made, or would have emotional difficulty adhering to them. Although there is a section in the document that states whether your decisions should be followed specifically or as guidance, these definitions have “grey areas” under real world circumstances.
  • Your designated family member is the primary beneficiary of your estate. It may be best to separate financial from personal health decision-making in this situation.

The most important part of making the decisions in the Advance Directive is talking about them with people you respect and care about, including your representative. Discussions help clarify your wishes and the reasons why you made them. The form is not valid without the signature of your representative, and after they have signed, you still need signatures from either two witnesses OR a notary before it becomes official. The witnesses can be anyone EXCEPT your health care provider OR your healthcare representative.

If you are not comfortable signing section A, you do not need to. As noted, another option is to specify illnesses or events for which you would want Section A to apply – for example: I have had a stroke. It can be helpful to think about the scenarios under which you feel life would be worth prolonging. Is the ability to eat, or speak, or move independently a critical factor for you?

Section B must be filled out in order to guide your healthcare representative. In this section, you can request tube feeding or other life support under four specific sets of circumstances: if you are close to death, permanently unconscious, with advanced progressive illness or at risk of severe pain and suffering. One option, if you are not certain, is to specify a time frame for which you would want the intervention – for example: “I want tube feeding for one month, and if there is no improvement in my condition, then remove it”. It is important to recognize that tube feeding and other life support interventions almost always take place in the hospital setting.

Download the Advance Directive Form

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