Health Care Directive and POLSTS

Joe is 45 years old and in good health.  He is about to go into the hospital for a minor procedure and his clinic asks him if he has a health care directive.  What is it and why would Joe need one?

A health care directive is a document that tells your health care workers who should make medical decisions for you if you cannot.  In Joe’s case, he chooses his wife, Jane, to be his health care “agent.”   If there is a mishap with Joe’s surgery , and he is unconscious, Jane will decide, with the doctor’s advice, between various options for Joe’s care.

Because any of us could become unable to make decisions, either temporarily, or permanently, every adult should have a health care directive.  There is no doubt that this document is the single most important estate planning document you can have.

Health Care Directives provide instructions to the person who will make medical decisions on your behalf. They are not just for deciding who will “pull the plug.”  In today’s world of medicine, there are many choices of treatment—some aggressive, others less so.  If Joe is unable to make his own decisions because he is too sick, his health care directive says who will make those decisions, including the decision of where to live.  The instructions contained in a Health Care Directive help Jane to make the kind of medical decisions that Joe would make if he were able.

Fast forward to the future—Joe is now 89 years old and suffering from Stage IV Lymphoma.   What happens when Joe collapses in his apartment?  Jane calls 911 because she is scared, but she knows that Joe would not want to be resuscitated.  What now?   If Joe had worked with his doctor and obtained a POLST (Provider Orders for Life Sustaining Treatment) and that POLST were easily available to the paramedics, those decisions would already be made and the paramedics would know whether to try CPR, or whether to intubate Joe.

POLSTs are provided only by physicians and nurse practitioners and are medical orders to other health care workers.  POLSTs are generally only for people who are approaching life’s end.  They do not replace Health Care Directives, but supplement them.  Like a Health Care Directive, photocopies and faxes of the POLST are valid.  Unlike a Health Care Directive, there is little flexibility in the POLST.  One must be even more careful and deliberate when completing a POLST than completing a Health Care Directive.

There are five sections to the POLST and 3 relate to care:

  • CPR vs. DNR
  • Goals for Treatment—comfort care to limited intervention to full intervention
  • Treatments—choices about use of antibiotics and nutrition/hydration

If there is a 911 situation, and the POLST is readily available for the paramedics, the first responders will follow the instructions of the POLST—at least in Richfield and in Minneapolis, MN.  Any care section not filled out will receive the presumption of aggressive treatment.  First responders will not take the word of a family member or other person that such a document exists—it must be provided.

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