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Ask The Expert: Advance Care Planning

April 16, 2019

What is the difference between an advance directive and practitioner orders for life sustaining treatment (POLST)?

Reverand Randy Parks, Chaplain, Newton Medical Center

On April 16, we will recognize National Healthcare Decisions Day, an initiative to help educate and empower the public and health care providers about the importance of advance care planning.

Two advance care planning tools available to residents of New Jersey include an advance directive, and the POLST (practitioner orders for life sustaining treatment). Both are complimentary documents but have some distinct differences as well.

First, an advance directive is a written document with directions regarding your health care, in case you are no longer able to make your wishes known. It includes two parts:

  1. The “living will” (not your financial will) or instruction directive. This is the part of the advance directive signed by you specifically stating kinds of care and life–saving, life-sustaining, and life-prolonging treatments you would or would not want at the end of life (and the conditions under which you would or would not want such treatments to be carried out) if you were no longer able to speak for yourself.
  2. Durable (or medical) power of attorney for health care (also known as the health care proxy or representative) – this part of the document appoints, in advance, someone to make healthcare decisions for you, to the best of their ability, in keeping with your interests and wishes as stated in the “living will” portion of the advance directive.

An advance directive can - and I believe, should – be filled out by any adult regardless of age, and be signed, dated and witnessed by two adults. You may also have your signature notarized and have one additional witness. An attorney is not necessary for this to become a legal document, though may be consulted if desired. Thus, having an advance directive (along with making 5-6 copies for physicians, loved ones, extra for hospital visits) is an effective means of maintaining some level of control and making your wishes known concerning your medical care if you become unable to make these decisions.

At Newton Medical Center we use a form prepared by Atlantic Health System as well as a form known as Five Wishes, but there are dozens of variations, including some that are specialized for various religious faith groups, as well as for citizens living with mental illness.

A second path toward making your health care wishes known toward the end of life is POLST. While advance directives are “statements of patient intention,” POLST is a set of medical orders, designed specifically for those who are seriously ill, frail, and elderly citizens. Produced on a distinctive green form and signed by both doctor (or advance practice nurse) and the individual or their surrogate, POLST specifies the types of medical treatment an individual wishes to receive at the end of life. Information included in a POLST form consists of:

  1. Goals of care for the individual – this is ideally specified in a heart-to-heart conversation with your health care provider
  2. Preferences regarding cardiopulmonary resuscitation attempts, use of intubation and ventilation for respiratory failure, artificially administered nutrition and hydration, and other medical interventions

POLST was developed in response to seriously ill patients receiving medical treatments that were not consistent with their wishes, usually due to a lack of clear communication between the patient, family members and the healthcare providers. The goal of POLST is to provide a framework for healthcare professionals so they can provide the treatments patients do want and avoid those treatments that patients do not want.

While filling out a POLST form is voluntary, NJ law requires that medical orders contained in a POLST be followed by health care practitioners, and provide immunity from civil or criminal liability to those who comply in good faith with an individual’s POLST.

- Rev. Randy Parks is Spiritual Care Manager/Chaplain for Atlantic Health System’s Newton Medical Center

Source: New Jersey Herald