Have you considered the medical decisions that may face you, or your spouse and family, if you are seriously ill or injured? What if you are unable to make a decision and need someone else to speak and act on your behalf? These significant questions are at the heart of two documents Aging Advisors discusses with all clients during our initial assessment – the Advance Directive, and the POLST. Both are tools in our advance care planning toolkit, but although we often discuss them together, they have important differences as well.
First, let’s take a look at the Advance Directive, which is a legal document. You do not need to have a lawyer to complete an advance directive, but you do need two witnesses! In Oregon, the advance directive form is a document which allows you to indicate your preferences for life support and tube feeding in four specific scenarios: close to death, permanently unconscious, advanced progressive illness, and extraordinary suffering. In addition, you can give a general instruction if you do not want life support or tube feeding under any of these circumstances. For each scenario, you have 3 options you can choose: I do want this treatment, I do not want this treatment, or I want this treatment “only as my physician recommends”. By choosing this option, your physician can try measures she or he thinks will help and discontinue if they are not doing so. You may also want to write additional instructions (an addendum) to your health care team and to your appointed decision makers, going into more details about your values, preferences and thoughts on specific situations.
In the Advance Directive, you can also name a Health Care Representative – someone who can make decisions on your behalf if you are unable to make your own decisions. You can also name an alternate, in case that person is unavailable. The Oregon Advance Directive document is currently under revision and a temporary version will be available soon, followed by a 2-year process to revise and update the form.
It is very important before filling out this document and selecting a health care representative that you take the time to think and talk through what these decisions mean with trusted advisors – your spouse, your children, your family and friends, and your health care providers. There is a lot of information online you can read but be aware of the source of the material! We recommend starting with the National Institute on Aging. A book that some groups and families find helpful to read and discuss is Being Mortal, a look at end of life care and decisions through both a professional and personal lens, by Dr. Atul Gawande.
The other document we often ask about is a POLST – Physician’s Orders for Life Sustaining Treatment. The POLST is a medical order, which you discuss and fill out with your doctor, and he or she signs it. Your doctor will discuss each item with you as you fill out the document, but you should review the sections and what decisions you will be making ahead of time so that you can have an informed conversation with your doctor. The POLST is the document that will tell emergency responders and medical staff what treatment you do, or do not, want in an emergency, including CPR, Medical Interventions, and artificial nutrition (tube feeding). It will be entered into a database or registry, so it can be quickly accessed in an emergency. It is also a good idea to have a copy on your fridge, and to carry a copy with you when you are out.
Both the Advance Directive and the POLST can be changed if and when you choose to do so. To change your Advance Directive, you need to fill out a new form and have it witnessed again. To change your POLST, you need to make an appointment with your primary healthcare provider.
Written by Bethany Wofford, MSSW