Follow-up to self-deception post: More on medical decisions

The End

This explanation is from the Washington State Medical Association, but it will probably apply in most states. Check yours out. If you have a serious health condition, you need to make decisions about life-sustaining treatment. Your physician can use the Physician Orders for Life-Sustaining Treatment (POLST) to represent your wishes as clear and specific medical orders, indicating what types of life-sustaining treatment you want or do not want at the end of life. POLST is not for everyone. POLST is designed for seriously ill individuals, or those who are in very poor health, regardless of their age. POLST complements an advance directive and is not intended to replace that document.

An advance directive is still necessary to appoint a legal health care decision-maker, and is recommended for all adults, regardless of their health status. And unlike an advance directive, POLST must be signed by both the patient and the attending physician, nurse practitioner or physician assistant-certified. The attending physician, ARNP or PA-C who signs the form assumes full responsibility for its accuracy.

The term ‘advance directive’ refers to your oral and written instructions about your future medical care in the event you are unable to express your medical wishes. There are two types of advance directives: a health care directive (also known as a living will) and a durable power of attorney for health care.

Health care directive (living will)

If you had a terminal condition, would you want your dying artificially prolonged? The health care directive is a legal document allowing you to answer this question in writing. This directive is used only if you have a terminal condition as certified by your physician, where life-sustaining treatment would only artificially prolong the process of dying; or you are certified by two physicians to be in an irreversible coma or other permanent unconscious condition and there is no reasonable hope of recovery. In either situation, the directive allows treatment to be withheld or withdrawn so that you may die naturally.

You may also direct whether you would want artificially provided nutrition (food) and hydration (water) stopped under these circumstances. Also in the directive, you can give further instructions regarding your care. The health care directive must be signed by you and two witnesses who are not related to you and will not inherit anything from you. You can change or revoke this directive at any time. The health care directive allows people who clearly do not want their lives artificially prolonged under the above conditions to make their wishes known.

Durable power of attorney for health care

Who would you want making your health care decisions if you were unable? The durable power of attorney for health care is a legal document allowing you to name a person as your health care agent—someone who is authorized to consent to, stop or refuse most medical treatment for you if a physician determines you cannot make these decisions yourself. The person you choose should be a trusted family member or friend with whom you have discussed your values and medical treatment choices.

Who can make decisions for me if I’m unable?

If you lose the ability to communicate and make decisions, Washington state law enables the following people, in order of priority, to make health care decisions for you, including withdrawing or withholding care: 1. A guardian with health care decision-making authority, if one has been appointed.

2. The person named in the durable power of attorney with health care decision-making authority.

3. Your spouse or state-registered domestic partner.

4. Your adult children.

5. Your parents.

6. Your adult brothers and sisters.

When there is more than one person, such as children, parents, or brothers and sisters, all must agree on the health care decision.

Making your wishes known in an advance directive will provide your doctor and your agent the clear guidance necessary to respect your wishes. The medical decisions made by your health care agent (as named in your durable power of attorney for health care) is as meaningful and valid as your own. The wishes of other family members should not override your own clearly expressed choices or those made by your agent on your behalf.

A durable power of attorney will allow for some flexibility regarding treatment decisions, since the agent that you choose to represent your wishes will be able to respond to unexpected changes in your condition and base decisions not just on your written wishes, but also on their familiarity with you and your feelings regarding your care.

A living will is necessary to provide instruction in case your agent is unable to serve, to provide evidence that the agent is acting in good faith in case the agent’s decisions are challenged, or to serve as the primary record of your wishes in case you are unable to appoint a health care agent.

Will advance directives be recognized in emergencies?

No. During most emergencies, there is not enough time for emergency service personnel to consult the patient’s advance directive. Once the patient is under the direct care of a physician, there will be time for the advance directive to be evaluated and/or the health care agent to be consulted.

What to do with these forms

Signed copies of your completed directives should be included in your medical record, given to any person to whom you give your durable power of attorney—including any alternate people you may have named—and to your personal attorney. Originals should be in a safe but accessible place (not a safe deposit box) or given to someone you trust and who can obtain them in an emergency.