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Advanced Directives (ADs) and Physician Orders for Life-Sustaining Treatment (POLST)

Part I

Advanced Directives

Advance Directives is a document that allows those who condone with it to acquire the legal capacity to make their own medical decisions about one’s end-of-life care ahead of time. As a resident of Florida, I have already dow

I downloaded my ADs form and filled it appropriately after sourcing it from the CaringInfo webpage. The AD concept that first came into effect in the 1960s allows persons to express their values and desires towards end-of-life care. These directives were created to prevent issues that may arise in the course of end-of-life care. They offer competent adults who can make sound decisions regarding their health (Klein & Cathy, 2005). It is common that, during the end-of-life period, individuals barely possess the ability to make sound medical decisions. Hence to protect patient autonomy, they are offered a chance to note down their desires earlier before that time (Karnik & Kanekar, 2016).

In my residence state, Florida, AD gives those adults competency in deciding to make decisions regarding their health. As stipulated within the Florida Statute § 765.101(1), an AD is regarded as a “witnessed written document or oral statement in which instructions are given by a principal or in which the principal’s desires are expressed concerning any aspect of the principal’s health care.” The form further encompasses the following for residents of Florida;

  • Designation of a Health Care Surrogate
  • Living Will, and
  • Anatomical Gift

The first type of AD, Designation of a Health Care Surrogate, allows one to make a selection of someone else (surrogate or an alternative to the first surrogate) who would make her medical decisions in case they become physically or mentally incapacitated. This directive may be a written or an oral statement. The second type, The Living Will, involves a written or oral statement by one composing of instructions on their desire about the provision, withholding, or withdrawal of life-prolonging medical procedures such as food and hydration in the cases when they exhibit end-of-life or prolonged vegetative characteristics. The third type, Anatomical Gift, notes how one will prefer their body parts to be handled; for example, usage is research, donation to other ailing patients, therapeutic, or educational use.

The Florida Statutes encourage every competent adult to own an AD speculating their beliefs and desires that will eventually protect their rights to autonomy on their medical matters during the events of physical and or mental incapacitation.

I entered into a critical decision-making process during the completion of the form. First, the document serves a crucial legal role that entirely concerns my medical matters and greatly depends on my beliefs and values for the provision of reasonable declarations (Page, 2019). One has to choose those who they prefer to be their surrogate carefully (Driesen, 2020). I had to carefully consider this area so that I could choose someone who would make decisions that I would make exactly if I were in the capacity to. In deciding about the anatomical gift, I first consulted my family, who are crucial resources when making medical decisions. Deciding on whether my useful parts of the body should be used in transplantation to other ailing patients who would be in need, or whether they should be used in research, therapeutic and educational matters, or whether I prefer none of the options was a bit challenging.

Part II

Physician Orders for Life-Sustaining Treatment (POLST)

POLST is a plan outlining one’s preferences regarding end-of-life care events and the physician’s decision depending on the medical evaluations they make. POLST gives critically ailing patients control over their terminal care hence specifying a more succinct understanding between a patient and a physician that can further be explained to other medical professionals (Mack, & Dosa, 2020). POLST reflects patients’ preferences about their terminal care and the intervention of medical technologies to prolong their life. Lovadini et al. (2021) note that, based on the evidence found on a systematic review of POLST, POLST has a more significant influence during terminal care than ADs alone.

The completion of the POLST form

POLST forms are only restricted to patients with advanced frailness or advanced life-limiting illnesses. Such illnesses are heart failure, cancer, lung disease, and serious neurological issues like Multiple Sclerosis. Further, the form is completed by a healthcare professional based on the medical manifestations and evaluations from the patient, and after a discussion with either the patient (if in the capacity) or the surrogate (as stated by the patient either in an Ads form) or the family. The completion of the form should significantly reflect the previous patient’s preferences. The final stage for validating the POLST form requires it to bear the patient’s signature or their surrogate’s/proxy (Tark et al., 2021).

ADs and POLST tied Together

The two initiatives, ADs, and POLST, are critical in honoring the wishes and desires of everyone in the events when they will face their terminal care. Humans are mortal, and death, therefore, is inevitable. Hence, making preferences earlier depending on your beliefs and values before the occurrence of that scenario when terminal care will be in effect is critical. However, the two have some differences. AD is eligible for all adults with or without serious illnesses or frailty.

On the contrary, POLST is only illegible for individuals with critical medical issues or deficiencies. Completion of AD can happen anywhere as opposed to POLST, which takes effect only in a medical setting where a medical expert is needed to make critical medical evaluations so that a rightful decision is made. AD is a directive where a patient gives directions about their medical journey when they enter terminal care and is not restricted to emergencies only. On the other hand, POLST is an order in an emergency and extreme events when the patient cannot make their own decisions, a surrogate in discussion with the medical expert can.

Medical Expert’s/ Registered Nurse’s Role for Patient’s Autonomy Matters

The above discussed critical initiatives to address end-of-life care issues among patients also rely on the medical professionals’ advice. When making medical decisions, medical professionals serve to discuss with the patient the merits and the demerits of their decisions to arrive at the most critical decision according to them (Miller, 2017). In so doing, medical professionals do not compromise patients’ right to autonomy; instead, they help them get a better understanding of their medical issues and their decisions and possible intervention measures (Kimani, 2020). Together with the patient, they determine the effectiveness of various treatment and care options supported by multiple clinical evidences. However, they do not choose their prospects over the patient’s.

Having had a critical exploration of the two terminal care programs put in place to address issues experienced in end-of-life care, it is clear that all medical practices take the concept of patient autonomy seriously. Despite the medical experts’ role in reasoning with the patients about their medical decisions, they always take note of the patients’ right to make their own informed decisions.


Driesen, M. (2020). Implementation of a Standardized Protocol to Select a Surrogate Decision-Maker for Trauma Patients. Medsurg Nursing, 29(4), 241-244.

Karnik, S., & Kanekar, A. (2016, June). Ethical issues surrounding end-of-life care: a narrative review. In Healthcare (Vol. 4, No. 2, p. 24). Multidisciplinary Digital Publishing Institute.

Klein, C. A. & Cathy, A. (2005). The importance of advanced directives. The Nurse Practitioner, 30(4), 11.

Kimani, D. (2020). Implementation of Advanced Directives (Doctoral dissertation, Washburn University).

Lovadini, G. B., Fukushima, F. B., Schoueri, J., Reis, R. D., Fonseca, C., Rodriguez, J., Coelho, C. S., Neves, A. F., Rodrigues, A. M., Marques, M. A., Bassett, R., Steinberg, K. E., Moss, A. H., & Vidal, E. (2021). To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients’ Preferences for Care at the End of Life?. Journal of the American Medical Directors Association, 22(2), 334–339.e2.

Mack, D. S., & Dosa, D. (2020). Improving advanced care planning through physician orders for life-sustaining treatment (POLST) expansion across the United States: lessons learned from state-based developments. American Journal of Hospice and Palliative Medicine®, 37(1), 19-26.

Miller, B. (2017). Nurses in the know: The history and future of advance directives. OJIN: The Online Journal of Issues in Nursing, 22(3).

Page, D. G. (2019). The barriers to completing an advance directive: The perspectives of healthcare professionals (Doctoral dissertation, The University of North Carolina at Chapel Hill).

Tark, A., Song, J., Parajuli, J., Chae, S., & Stone, P. W. (2021). Are we getting what we want? A systematic review of concordance between physician orders for life-sustaining treatment (POLST) documentation and subsequent care delivered at end-of-life. American Journal of Hospice and Palliative Medicine®, 38(9), 1142-1158.


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