Questions and Answers
- My son wants me to get an advance medical directive. I already made a living will a few years ago, isn’t that enough?
- A Living Will is a document that tells others, your doctors and family, what type of medical care you would like to receive should you become terminally ill or permanently unconscious. It can advise whether you do, or do not, want such things as a respirator or feeding tubes to be used, or measures such as surgery, or experimental drugs or treatments to prolong your life. In Michigan, there is court precedent that a living will is a legally binding document, but there is not a law stating this.
An Advance Medical Directive goes a bit further as a legally binding document in which you appoint who you want to make medical decisions and what your end-of-life wishes are if you become unable to make medical decisions on your own. This Patient Advocate, or Durable Power of Attorney for Health Care, has the responsibility to make a reasonable effort to ensure your instructions are followed. A living will, then, can explain what your wants are, but an advance directive states who will make sure your choices are implemented. It can be a more flexible document because your patient advocate has the ability to respond to unexpected situations.
Another legal document that can be completed, often in conjunction with a living will or an advance directive, is a Do Not Resuscitate Order (DNR.) A DNR indicates that no one take measures to revive you if your heart and breathing stops. If this is a choice expressed in your living will or advance directive, it might be useful to have a DNR as well, since a person can be competent up to the moment that death occurs, in which case a living will or advance directive would then never take effect.
There are numerous online resources and blank forms for use in completing a living will, advance directive, or DNR. Area Agency on Aging Region IV’s resource library also has forms available. Stop by, or call our Info-Line at 800-654-2810 if you would like something sent to you.
- My mother-in-law, who lives in another state, is terminally ill, but is hoping to attend our daughter’s wedding two months from now. She has had a do-not-resuscitate order for quite a while, but says she now has a “physician’s order for scope of treatment” document that can override the DNR order, temporarily. What exactly is this?
- The Physician’s Order for Scope of Treatment (POST) document is a newer legal form, for which laws have just recently passed allowing for its use in Michigan. Also known as Physician’s Order of Life Sustaining Treatment (POLST) these forms originated in Oregon in response to that state’s assisted suicide law, and have been in use in several other states as well.
The National POLST Paradigm Program Task Force states that POST or POLST forms are not advance directives, but rather portable, actionable medical orders. These orders are for the treatment of a specific condition, which direction could include end-of-life choices. They have a limited time frame and limited function, designed to be an advance care planning tool for seriously ill individuals whose health care professionals would not be surprised if they died within a year. These forms are completed after discussions between a health care provider and the patient (and/or the patient advocate) in which the physician details diagnosis, prognosis, and treatment options -- including benefits and burdens of each --and the patient shares his/her values, beliefs, religious and ethical concerns, and goals of care, which might include personal life goals based on current circumstances. After this informed, shared decision-making process, the treatment plan is documented and the POLST form is signed by the physician.
In most cases, if a patient has a pre-existing advance directive or DNR order, the POST form will take precedence as the more current expression of the patient’s wishes. Without knowing all the details, it might be that your mother-in-law has a POST that would allow for treatments and even resuscitation to prolong her life until after her granddaughter’s wedding, at which time she can choose to revoke the POST or revise it to be in line with her previous advance directive and DNR order.
While the new law goes into effect for Michigan in February, 2018, implementation and use will be delayed until State agencies have developed a standardized form. For more information about POST/POLST forms, go to http://polst.org