ADVANCE HEALTHCARE DIRECTIVES
In December 2017, doctors at a Florida hospital faced an interesting ethical dilemma when an unconscious man was wheeled into the emergency room with the words “Do Not Resuscitate” tattooed on his chest.
The 70-year-old patient arrived at the hospital without family, friends, or any type of identification. The only clue the doctors had regarding his end-of-life wishes were the three words permanently inked below his collarbone.
Despite the seemingly clear message, doctors were still conflicted about how to proceed. Should they really make such a critical decision based off of a tattoo? What if the patient had gotten it 10 years ago and had since changed his mind? Without any type of DNR, Advance Healthcare Directive, living will, or other indicative document, the doctors were unsure of the patient’s true and current wishes.
This unusual situation has led doctors around the country to encourage their patients to create advance care planning documents with clear-cut directions on how to approach end-of-life decisions.
Most people are familiar with the standard Advance Healthcare Directive, but there are other documents that can be utilized as well. The following are some of the most commonly used medical forms and documents used in emergency and end-of-life scenarios.
ADVANCE HEALTHCARE DIRECTIVE
An Advance Healthcare Directive (AHCD) is a legal document that specifies who will carry out your wishes regarding medical treatment in the event that you are unable to do so yourself.
A Healthcare Power of Attorney is a type of AHCD that allows you to appoint an individual, called an agent or healthcare proxy, to make decisions about your medical care in the event of your incapacity (for example, if you are in a coma).
A living will is another type of AHCD that lays out instructions for your medical care so that your agent has a clear understanding of what your wishes are. For example, you can state that, upon your passing, you wish to be cremated and have your ashes spread at sea.
A Physician Orders for Life-Sustaining Treatment (POLST) is a medical form, usually printed on bright pink paper, which details the specific medical treatment that you want (or don’t want) during a medical emergency. The purpose of a POLST is “to prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that the individual’s wishes are honored.” (www.capolst.org.)
It’s important to note that a POLST does not replace an AHCD - rather they work in tandem. While it is recommended that all individuals create an AHCD, only those with a serious illness (i.e., someone who may pass away within the next year) need to complete a POLST.
A DNR (“Do Not Resuscitate”) order instructs medical personnel to withhold resuscitative measures in the event that you stop breathing or your heart stops beating.
Such measures include cardiopulmonary resuscitation (CPR), assisted and/or artificial breathing procedures, endotracheal intubation, defibrillation, and other invasive actions. Without a DNR, emergency and healthcare care providers will attempt to resuscitate a patient.
DNR clauses can be incorporated into a living will or AHCD, but can be stand-alone forms as well. Both types allow you to express your resuscitative preferences if you are not able to communicate your wishes if and when the time comes.
Five Wishes is a specific type of living will and Advance Healthcare Directive hybrid created by the non-profit organization Aging with Dignity. Proponents of Five Wishes appreciate this type of document because of its incorporation of personal, emotional, and spiritual elements.
The Five Wishes refer to: 1) Who you want to appoint to make medical decisions on your behalf if you are unable to do so yourself; 2) The type of medical and life support treatment you wish (or don’t wish) to receive; 3) How comfortable you’d like to be, taking into account pain management, quality of life, etc.; 4) How you’d like to be treated by others during your last days; and 5) What you want your loved ones to know.