Whether you’re planning for your own end of life care or preparing to make decisions on behalf of someone else, no document is more important than the Advance Directive. There are various forms available to meet the exact situational needs of individuals , and people may complete multiple versions of the form throughout their lives as their situations change.
An Advanced Directive is a simple form that gives a person a voice and say in their care even after they’ve lost the ability to speak for themselves. It is enforceable as long as the form was completed in good faith, the state restrictions are met, and the wishes stated are legal in the local jurisdiction.
What are Advance Directives?
What is an Advance Directive?
An Advance Directive is a statement of your wishes for medical care, should you be unable to speak for yourself if you are permanently or temporarily incapacitated, either by injury, accident or a major health crisis. While most commonly associated with end of life care, an Advance Directive becomes effective anytime a person is unable to make their own decisions. An Advance Directive allows you to:
- name someone you trust, also known as an agent or substitute decision maker, to speak on your behalf
- leave specific instructions for different potential situations
- identify your priorities
- communicate your wishes to your loved ones and medical providers
There are a number of different forms available through private organizations, states and provinces. Follow this link to Complete Your Advance Directive in 3 Easy Steps.
Is an Advance Directive the same as a POLST or “Physician Order for Life Saving Treatment” form?
An Advance Directive is NOT the same as a “Physicians Orders for Life Saving Treatment” or POLST though this is a common misconception. Another misconception is that an Advance Directive is used to withhold life saving treatment, though this couldn’t be further from the truth.
The POLST, widely adopted throughout the US and Canada over the past 30 years, is a form often used by hospice or hospitals when a patient is nearing death. It is a legal form which authorizes specific medical treatments based on known and expected medical circumstances; it covers both life extending and comfort care. For example, someone with respiratory failure may request to maintain oxygen supplementation even after other “life extending” treatments have been ceased.
Both the Advance Directive and POLST are used to prepare for end of life however there are a number of significant distinctions between the two, outlined in the chart below.
An Advanced Directive vs. A POSLT
|An Advance Directive is…||A POLST is…|
|…useful for any adult, regardless of health status||…often required by medical or hospice staff when someone is nearing death|
|…names an agent or surrogate to make decisions based on your wishes and requests||…authorizes medical providers to provide specific treatments|
|…states general wishes based on unexpected circumstances||…addresses specific treatments based on current predictable circumstances|
|…general in scope and can be in place for years||…narrow in scope and used when death is imminent|
|…especially valuable to the loved ones who may need to make decisions on your behalf||…especially valuable to the emergency, medical or hospital staff who will act on your orders|
When used in conjunction, the wishes stated in an Advance Directive will translate into the specific medical orders documented in the POLST. The two documents are best used together as support for the person facing death, their care circle and the medical team.
Thanks to countless movies and hospital shows on TV, many people are familiar with DNR or “Do Not Resuscitate” orders but the reality is more complex. Since the 1990s, most states throughout the US and Canada have adopted the POLST or “Physician Order for Life Saving Treatment” and phased out references to no-code, DNRs and other “non-treatment” based terminology, though the phrases remain a part of our cultural language.
If you want doctors to make every attempt to extend your life, you can put that in your Advance Directive and POLST. If you want to decline naturally without any type of medical intervention, your Advance Directive and POLST can also both state that. And, if you want to ensure that your comfort is prioritized and your pain is managed, regardless of your life expectancy, you can state those wishes in your Advance Directive and POLST as well.
What are the components of an Advance Directive?
There are four basic components of an Advance Directive including:
- Basic information about the individual
- Naming the agent or substitute decision maker
- Detailed and specific wishes or requests for care
- Signature and witness signatures
Are there Advance Directive resources in languages other than English?
- Arabic: Info Overview (bilingual)
- Chinese/Mandarin: Info Overview (bilingual)
- Chinese/Cantonese: Info Overview (bilingual)
- Japanese: Info Overview (bilingual)
- Russian: Info Overview (bilingual)
- Somali: Info Overview (bilingual)
- Spanish: Info Overview (bilingual), Legal and Financial Planning for People with Alzheimer’s
Author: Megan Carmichael, Independent Funeral Consultant
Author Bio: Megan thinks and writes about the intersection of death and daily life for her blog, www.dailylifeanddeath.com, and other publications. Her background in marketing and wealth management led to working in the deathcare industry after the loss ofher mom in 2017 and dad in 2019. She lives in Ventura, CA with her husband and two young children.