An advanced directive is a document that has been legalized and explains how we want medical decisions about us to be made if we are not at a point of making our own. It allows the healthcare personnel and those close to the patient to know what kind of health care a patient should be given when they cannot decide. They are two kinds of advance directives: the health powers of attorney and the living will. As a healthcare worker, a living will express what a person prefers for future medical treatments and, in particular end of life care. This is when the person is not at a point of making a healthcare decision by himself. In the category of a healthcare power of attorney, a healthcare agent appoints an individual to make decisions for the patient when not in the capacity to do so.
In most cases, patients tell their doctors their preferences directly. When a person’s capacity to make or communicate healthcare decisions has deteriorated, another method of making and communicating findings is required. Advance instructions are used to fulfill this situation. If no advance directive has been made, a person designated by state law or chosen by a court may be entrusted with making healthcare choices. When a patient lacks capacity and has not selected a health care agent, many states allow for default surrogate decision-makers, generally family members (Klein, 2015). When the state’s laws do not give legal authority to the decision-maker, the healthcare personnel turns to the immediate next of keen even if the extent of the legal jurisdiction between them is less. In those situations where the issue has to be handled by the court, the court prefers to name a family member to make healthcare decisions, and on the same note, they can turn to a friend or a stranger.
A living will is a restricted document that states a person’s medical care wishes in the future. It is always referred to as “living will” because it is enforced while a person is still alive. A living will generally focus on end-of-life care, although it can also include directions for treatment or care. Living wills are only valid if the individual has lost the ability to make healthcare decisions and suffers from a state-defined condition, such as a terminal illness or persistent coma. Some states accept other diseases, such as advanced Alzheimer’s disease or any condition listed in a living will. Many people think that dying is preferable to being reliant on medical devices for the rest of their lives or having no possibility of regaining a certain quality of life (Weathers et al., 2016). Others believe that heroic methods and technology should be employed to extend life as long as feasible, regardless of the level of medical intervention necessary or the resulting quality of life. A living will give a person the option of expressing one or both of these desires. Because most precise treatment decisions are unpredictable, including information in possession will regarding fundamental beliefs linked to end-of-life care, personal priorities, and care objectives can be just as valuable as specific treatment preferences.
A living will conform to state law requirements as to how the document is signed and witnessed and what must be contained in the document’s content to be legally valid. Many states have forms that citizens might utilize if they require them. Hospitals and other healthcare providers, municipal offices on aging, and law organization websites are all excellent places to look for samples of appropriate forms. To receive Medicare or Medicaid payments from the federal government, some provider firms must comply with the legislation. However, the law’s provisions apply to everyone who enters these institutions (or is treated by these doctors), not only those who are on medications.
Filling an advanced directive form is not as difficult as people think. I obtained mine from the national hospice and palliative organization, which has a list of advanced directive forms for all the states. What is included in the document is the name and contacts of the healthcare agent. Some questions ask an individual about their preferences if they fail to make decisions. Names and signatures of the witnesses are also a requirement by the state. At the end of the filling, there is the signature and seal of a notary public of that place.
The Physician Order for Life-Sustaining Treatment (POLST) is an order by the physician that explains the plan of end-of-life care that reflects what the patient prefers when the physicians judge medical treatment means and evaluation (Lee et al., 2020). Its main goal is to allow a physician and patient to create default orders for end-of-life care that can be communicated succinctly and clearly to other healthcare professionals. A physician completes this form once they have seen that a patient’s illness won’t last long and the death of that won’t be a surprise to anyone. The patients who fill such forms are those with metastatic organ diseases and those residing in long-term facilities. Both the physician and the patient must sign the POLST form. For this form to be legal, the physician must sign it to approve the patient’s document.
There are differences between Advance Health care and the POLST, as shown in the following discussion. A POLST form differs from that of a Health Care Directive because, for the POLST, a physician has to write and sign it (Vearrier, 2016). When filling, doctors come together with the patients, and they record what the patients want to be done in case they become unable to make decisions by themselves. The Health Care Directives are prepared in advance of medical issues. In this case, POLST forms are completed when a critical medication arises, changing the current condition. The POLST forms are not available in each state, while the Advance Directives are recognized in all the states regardless of the current health. For the POLST, any adult, either a child or parent with a severe illness, would not be surprised if the patient dies that sooner.
The Advanced Directives is written by an individual with or without an attorney, while for the POLST, the physician does the filling after consulting with the patient. Advanced Directives is completed in any setting while the POLST is filled in a medical environment. Advanced directives do not apply for emergency care, and the patient and the family have the produces the form in case the healthcare practitioners need them. The POLST uses for emergency care, and it is the responsibility of the practitioners to make the document in case it is required.
The RNs play a vital role in assuring the patient’s right to autonomy in choosing the healthcare interventions the patient does or does not want. The doctor has to consider how to respect both his independence and the views of the patient’s family alongside the patient’s decision. Respecting the patient’s autonomy is acknowledging the patient’s decisions even when they are not in a position to communicate. It mandates that physicians respect patients’ autonomy by providing them with the information they need to comprehend the risks and benefits of a proposed intervention and acceptable alternatives (including no intervention) so that they may make their own decisions.
References
Klein, C. A. (2015). The Importance of Advanced Directives. The Nurse Practitioner, 30(4), 11. https://doi.org/10.1097/01.npr.0000393493.25977.ca
Weathers, E., O’Caoimh, R., Cornally, N., Fitzgerald, C., Kearns, T., Coffey, A., Daly, E., O’Sullivan, R., McGlade, C., & Molloy, D. William. (2016). Advance care planning: A systematic review of randomized controlled trials conducted with older adults. Maturitas, 91, 101–109. https://doi.org/10.1016/j.maturitas.2016.06.016
Lee, R. Y., Curtis, J. R., & Kross, E. K. (2020). Physician Orders for Life-Sustaining Treatment and ICU Admission Near the End of Life—Reply. JAMA, 324(6), 608. https://doi.org/10.1001/jama.2020.8654
Vearrier, L. (2016). Failure of the Current Advance Care Planning Paradigm: Advocating for a Communications-Based Approach. HEC Forum, 28(4), 339–354. https://doi.org/10.1007/s10730-016-9305-0
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