Introduction
There are cases when a person is hanging between life and death not being able to say or do anything. Seeing him or her in such a condition brings constant pain and suffering to relatives and draws resources from both medical institutions and the pockets of a family. The latter hesitate on what to do, concerning themselves with moral questions of ending a life, while medical workers are simply not authorized to terminate a patient’s life using their judgment continuing to preserve it to the best of their abilities. An Advance Health Care Directive (AD) and physician orders for life-sustaining treatment (POLST) are aimed at resolving such issues giving a patient an instrument to decide his or her fate when unable to voice any wishes. However, the nature of these tools can be somewhat obscure and may need explanation and differentiation.
The Advance Health Care Directive
I obtained my Advance Directive on the website CaringInfo, a program of the National Hospice and Palliative Care Organization that informs and educates people on how to organize the process of care beyond the point of them not being able to make decisions. According to the American Bar Association (2017), every state recognizes documents that contain a will of terminally sick or soon-to-be mentally incapacitated people on how to proceed with their treatment or body. However, the authors note that not every wish may be granted in every state (American Bar Association, 2017). Some states provide a standardized legal form for expressing your preferences.
In Florida, Advance Directives are fully compliant with the law according to Florida Civil Rights Act, Chapter 765 (“The 2017 Florida Statutes,” 2017). The chapter discusses the terminology and procedures in detail. It gives the appropriate formulas for will expression and determines what an AD should encompass. An AD provides a chance to authorize a specific person to make decisions concerning your care or determine care procedures for yourself in the event of your inability to communicate wishes personally. The latter should be confirmed by your physician for an AD to become effective.
My experience with filling out an Advance Directive was rather straightforward and unemotional. I already thought about the situation when I would have a terminal condition. Despite my age, I already have a procedure in mind that includes life-prolonging measures being terminated immediately after I am diagnosed with incurable, end-stage disease or indefinite vegetative state. Therefore, it was an unexpected fact to know that, according to a recent study, many people do not have a planned set of actions in the event of their inability to decide their fate (Halpern, 2013).
Physician Orders for Life-Sustaining Treatment Form
POLST is a medical document that is completed and signed by a professional healthcare provider. It includes the treatment procedures and their nature, which is discussed between a health care expert and a patient. A POLST directly reflects the will of the latter. It can determine, which procedures should be preferred and which should be avoided when a patient is no longer in the condition to make such decisions. As for the moment when the form needs to be completed, the initiative may come only from a physician, who sees that standard procedures aimed at saving and prolonging life are second-guessed by the dying patient (“POLST Paradigm Fundamentals,” 2017). Only the expert medical worker, who is legally responsible for their treatment decisions, can initiate a POLST conversation and sign the resulting document.
The Differences between an Advance Health Care Directive and a POLST
There are certain fundamental differences between an AD and a POLST. Firstly and most importantly, the former is created and signed by the person who wants it, while the latter is initiated and underwritten by an authorized care provider. Any adult can have their AD anytime he or she wants, whereas a severe, life-threatening condition needs to be diagnosed before a person is qualified to have a POLST conversation. As for the content of the two documents, there are also certain specifics. An Advance Healthcare Directive outlines a general way of how to proceed with treatment in case of mental inability to convey wishes on the subject. The orders for treatment, on the opposite, often enumerate specific procedures. Additionally, the nature of an AD is legal and may be considered a will. A POLST is mainly a medical document that is more of a supplement to an AD if a patient has one.
Conclusion
All things considered, both POLST and AD are important if a person at death’s door wishes to plan for what comes after he or she is no longer capable of influencing the way he or she is treated. According to Rao, Anderson, Lin, and Laux (2014), the main obstruction to people voicing their will on medical therapy is the lack of information on the possibility itself. A recent study says that the AD primarily targets the elderly, who are surprisingly rarely aware of it (Rao et al., 2014). I believe that an RN’s goal here is to make sure patients, who might need to consider their treatment options, are informed of the ways to change them. Moreover, an RN needs to instruct patients on how to do it properly as not everybody is capable of making sense of the statutes. The least he or she could do is to advise to consult a lawyer. With the two documents properly composed a person may be almost a hundred percent sure that his or her will is fulfilled.
References
American Bar Association. (2017). Living wills, health care proxies, & advance health care directives. Web.
Halpern, S. D., Loewenstein, G., Volpp, K. G., Cooney, E., Vranas, K., Quill, C. M.,… & Arnold, R. (2013). Default options in advance directives influence how patients set goals for end-of-life care. Health Affairs, 32(2), 408-417.
POLST paradigm fundamentals (2017). Web.
Rao, J. K., Anderson, L. A., Lin, F. C., & Laux, J. P. (2014). Completion of advance directives among US consumers. American Journal of Preventive Medicine, 46(1), 65-70.
The 2017 Florida statutes (2017). Web.