Part I: Advanced Directives (ADs)
The sample National Hospice and Palliative Care Organization (NHPCO) advanced directive (AD) located in the caringInfo website meets the legal requirements for ADs in Florida. Section 765.101 of the Florida Statutes requires that ADs meet several needs (Florida Agency for Healthcare Administration, n.d.). The section also determines what an AD is. According to the law, an AD is an instruction of what patients want to happen to them should they be incapacitated and therefore unable to make decisions. For instance, if a person’s heart stops, they can choose whether they should be resuscitated or not using an AD because when the event happens, they will lack the competence they need to decide. They also instruct on whether organs and blood should be given should they be needed. Florida laws also recognize three AD types. They are surrogate documents, living wills, and anatomical donations.
The AD I downloaded from the provided link has all the aspects needed for Florida ADs. First, it requires two witnesses to sign. The witnesses must ensure that the patient’s freedom was respected in its signing. It also listed the required conditions for the AD to apply. For instance, the living will become applicable when one enters a vegetative state, has a chronic condition, or their condition is terminal (Florida Agency for Healthcare Administration, n.d.). The law also requires the date of the document’s signing to be included and the terms used to be defined. The law recognizes that signatories are not always professional. Hence, they may not understand jargon.
The legal requirements for the different ADs also vary slightly. The differences should be considered to have legally valid documents. For instance, both signatories of the living will cannot be patients’ relatives. One must be unrelated to them. The law included the provision to protect patients from situations where their kin can force them to sign (Florida Agency for Healthcare Administration, n.d.). It is also mandatory to declare the organ one will allow to be extracted for donation in organ donor forms.
The filling of the living will be simple. The document avoided jargon, making it easy for a layperson to follow. It was designed to promote informed consent. Hence, using simple language that allows easy understanding aligned with its goals. Using jargon may cause people to agree to things they do not comprehend and enable selfish parties to exploit their situations.
Part II: Physician Orders for Life-Sustaining Treatment (POLST)
POLSTs are physician-filled documents with orders from patients’ physicians that enable them to determine the treatments people should be given and what should be avoided when they cannot communicate or when they lose their capacity to instruct physicians. Even though Florida laws do not have requirements for POLSTs, other states that have them also have requirements they must meet (National POLST, 2023). The forms are important because they contain information that can be vital, especially in emergencies when patients are incapacitated and may need specific life-sustaining treatments or measures to avoid adverse events. For instance, for people who have allergies to some medications, the documents from their physicians may save them from further emergencies by indicating the treatments that should be given.
Chronically ill people who have underlying issues that may present threats to their lives usually need POLSTs. Such people need to have the information in the forms with them because it contains the special treatment that they should get to limit medical problems that may occur from treatments that are not recommended. The information in the documents is also usually clear to ease its application. Usually, chronically ill people whose issues are also severe face limitations and increased emergency risks. Hence, they also face increased risks of needing to visit hospitals. Having enough information about treatments that one should be given makes decision-making quick for providers when such people are involved in emergencies.
Physicians must file the forms. Therefore, usually, when one needs POLST forms, they must consult their providers, who will assess if they meet requirements before signing (National POLST, 2023). If the requests are given to physicians, they help patients fill the needed information and sign them to show their validity. POLSTs become applicable to providers who sign as well as others who may be within the facility or outside (National POLST, 2023). They also apply for emergency personnel who respond to issues.
The document, as their names suggest, must be signed by physicians. They also need patient signatures or their surrogate’s signatures. Finally, after all other aspects are filled, physicians must certify they are valid by signing (Constantine et al., 2021).
Part III: Summary and conclusion.
ADs and POLSTs are both signed before when they are needed to be valid. However, they also have differences. First, the documents’ goals differ. For instance, in ADs, the documents contain patients’ wishes (Rowe et al., 2020). Hence, they instruct professionals on treating people when certain things happen. For instance, when they become unconscious, the document may direct that one should not be resuscitated if it is their wish. However, in POLSTs, physicians give direct instructions on specific treatments (National POLST, 2023). Therefore, they are treatment instructions rather than just declarations of patients’ wishes. Second, from their structures, POLSTs only need patients’ or their surrogates and their physicians’ signatures. ADs, on the contrary, must include two witnesses (Constantine et al., 2021). The witnesses must also include a person who lacks any familial relationship with the patient in living wills (National Hospice and Palliative Care Organization, 2023). The witnesses must sign alongside the patient and providers involved. Usually, the professional who signs ADs can be an APRN. Additionally, unlike ADs, which can be signed to people of various health statuses and become active in critical times, POLSTs are only given to people with high chances of adverse situations that relate to their chronic severe conditions. Finally, in Florida, only ADs are legally recognized. Therefore, POLSTs are not regulated in the state and are not a requirement.
APRNs should help protect patients’ rights, like informed consent, during the signing of ADs and POLSTs. They can play the role of witnesses and offer the needed education that patients may need to decide if they should get the documents (Constantine et al., 2021). They should also ensure that they follow the documents when they see them because they communicate people’s wishes and may also affect their end-of-life journeys.
References
Constantine, L. A., Wang, K., Funk, D., Speis, A., & Moss, A. H. (2021). Use of a state registry to compare practices of physicians and nurse practitioners in completing physician orders for life-sustaining treatment forms. Journal of Palliative Medicine, 24(7), 994-999. https://doi.org/10.1089/jpm.2020.0515
Florida Agency for Healthcare Administration. (n.d.). Healthcare Advanced Directives. Retrieved from AHCA: file:///C:/Users/DON/Downloads/HealthCareAdvanceDirectives-English.pdf
National Hospice and Palliative Care Organization. (2023). Florida Advance Directive. Retrieved from Caringinfo: https://www.caringinfo.org/wp-content/uploads/Florida.pdf
National POLST. (2023). Honoring the wishes of those with serious illness and frailty. Retrieved from National POLST: https://polst.org/
Rowe, J. G., Potts, M., McGhie, R., Dinh, A., Engel, I., England, K., & Sinclair, C. T. (2021). Palliative care practice during the COVID-19 pandemic: a descriptive qualitative study of palliative care clinicians. Journal of Pain and Symptom Management, 62(6), 1111–1116. https://doi.org/10.1016/j.jpainsymman.2021.06.013
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