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Advance directive

What Is An Advance Directive?

An advance directive is a written document that provides an outline of a patient’s health care wishes for medical treatment in the future. The patient’s wishes are the results of advance care planning and are stated in case the patient will not be able to make a health decision because of the patient’s illness or medical issue. The advance directive serves as a guide for the patient’s family and the patient’s medical team when they need to come up with a decision when the patient is unable to decide because of the patient’s medical condition.


Types Of Advance Directives

Living Will

There are several types of advance directives. The first type of advance directive is the living will. The living will is a legal document that states the patient’s preferred healthcare decisions in the future in case the patient is unable to make the healthcare decision. The patient’s incapability of making healthcare decisions usually happens at the end of life when the patient’s body is terminally ill or permanently unconscious. The healthcare decisions in the living will are about the treatments that will be given consent or rejected. The treatments depend on the current health conditions of the patient, whether they are to prolong the life of the patient or to stop if the chances of recovery are very slim.

There are several healthcare decisions that can be included in the living will, according to the National Institute on Aging (NIA). The first healthcare decision is using cardiopulmonary resuscitation (CPR). CPR is done to restore the patient’s heartbeat when it stops or when it is in a life-endangering abnormal rhythm. There are several ways to do CPR, such as manual CPR, which pushes the chest repeatedly with force, and defibrillation, which uses electric shocks. The patient can wish specifically for a do not resuscitate order. A do not resuscitate order instructs the patient’s physicians not to use CPR if the adult patient’s breathing or heartbeat stops.

The second healthcare decision in the living will is the use of ventilators as emergency treatment. Ventilators can help the patient breathe through a tube connected to the patient’s windpipe from the ventilator machine. The use of ventilator machines can be uncomfortable for the patient, which is why sedation of the patient may be required. The patient can include in the living will whether to use ventilators to keep the patient’s alive.

The next healthcare decision that can be included in the living will is the use of artificial nutrition and hydration. Artificial nutrition is administered through a feeding tube, inserted through the patient’s nose down to the patient’s stomach, that supplies the patient’s body with nutrients. Hydration is given through IV fluids that are delivered through the vein of the patient. Artificial nutrition and hydration are beneficial for the patient when the patient is recuperating from an illness. On the other hand, the patient can decide whether to receive artificial nutrition and hydration towards the end of life.

Another healthcare decision in the living will is the use of comfort care or palliative care. Comfort care and palliative care are given to relieve the patient’s pain and symptoms due to the illness. If the illness is in a terminal condition, when the doctor declared that the patient has only 6 months to live or less, the patient can include comfort care or palliative care in their healthcare preferences.


Durable Power Of Attorney For Healthcare

The second type of advance directive is the durable power of attorney for healthcare. The durable power of attorney for healthcare or the medical power of attorney is a legal document in which the patient elects someone to be the patient’s healthcare proxy or health care agent. A health care proxy or health care agent is the person authorized to make medical decisions once the patient is declared by the patient’s physicians to be incapable of making such decisions. These healthcare decisions are aligned with the patient’s wishes and preferences that are written in the patient’s living will.

The patient’s healthcare proxy or health care power of attorney must be someone the patient trusts and know well because the healthcare proxy will be carrying out the patient’s wishes and instructions. In case of the primary healthcare proxy’s unavailability or unwillingness in emergency situations, the patient can also elect a secondary or backup healthcare proxy.


Physician Orders For Life-Sustaining Treatment (POLST)

The next type of advance directive is the Physician Orders for Life-Sustaining Treatment (POLST). POLST, or Medical Orders for Life-Sustaining Treatment (MOLST), is a document that outlines the patient’s wishes during an emergency situation. The patient can include in the POLST form whether to use CPR or ventilators if necessary during an emergency. The POLST form must also be signed by the patient’s health care team so the patient’s emergency medical technicians (EMT) and paramedics can use it immediately during an emergency.


Do Not Resuscitate (DNR) Order

The next type of health care advance directive is the do not resuscitate (DNR) order. The DNR or do not attempt resuscitation (DNAR) or allow natural death (AND) order is a document to instruct the patient’s medical staff regarding resuscitation measures. Resuscitation measures include the use of cardiopulmonary resuscitation (CPR), automatic external defibrillator (AED), and life-sustaining machines like ventilators. There are two types of DNR orders: the hospital DNR order and the non-hospital DNR order. The hospital DNR order instructs the health care team, such as doctors and other health care professionals when the patient is in the hospital or nursing facility while a non-hospital DNR order is intended for emergency medical service (EMS) teams when the patient is outside the hospital or health care facility.


Organ Donation And Tissue Donation

Another type of advance directive is organ donation and tissue donation after death. Organ donation and tissue donation allow the patient’s organs, such as heart, lungs, pancreas, kidneys, corneas, liver, and skin, to be donated and transplanted to people who need them. Organ donation and tissue donation after death have no age limit, and some states permit adding the decision on the driver’s license.


How To Get Advance Directives

To get advance directives, the advance directive forms can be downloaded from the government’s website of your state. Your state’s government website contains the latest advance directive forms. You can access your state and territory government websites at USA.gov. USA.gov provides government information services that are accessible anytime, anywhere, from any channel.


Advance Directive Forms

Advance directive forms vary from state to state in the United States. They consist of several parts. The first part is the power of attorney for health care. The power of attorney for health care part designates your healthcare agent or healthcare proxy to make healthcare decisions for you. This part requires the full name, address, and contact details of your healthcare proxy or healthcare agent. You can also include the names and details of your first and second alternate healthcare agents in case your primary healthcare proxy’s authority were revoked or your healthcare proxy is unwilling or reasonably unavailable to make healthcare decisions for yourself. This part also states when your healthcare agent’s authority will be effective, your healthcare proxy’s obligations, and your healthcare agent’s authorization in case of organ donation and tissue donation to persons in need.

The second part of the advanced directive form is the instructions for healthcare. Instructions for healthcare consist of end-of-life decisions about whether to prolong or not to prolong your life. You can also state your desire for hospice care or palliative care to relieve your pain and symptoms and improve your quality of life. You can also put additional wishes which are not stated in the form.

The third part is the donation of organs, tissues, and parts at death. The donation of organs, tissues, and parts at death states your willingness to give your organs, tissues, and parts. This gives your healthcare agent the authority to give consent to any temporary medical procedure that will evaluate or maintain your organs, tissues, and other parts for donation purposes. You can specify the purpose of donation which are for transplant, therapy, research, or education.

The next part of the advance directive form is the primary physician. This part is optional and allows you to designate the following doctors as your primary physician. Your primary physician and alternate physician need to provide their names, addresses, and contact information.

The last part is the signature part. The signature part is where you affixed your signature and the date when you signed the form. This part also contains the signatures, names, and contact information of your adult witnesses. Your witnesses must also sign and declare under penalty of perjury that they know you personally, that they are not related to you by family, marriage, or adoption, that they are not your healthcare agent, and that they are not your health care provider.


Can You Change Your Advance Directive?

Yes, you can change or revoke your advance directive by creating a new advance directive. Your new advance directive must be distributed again to your family, your doctor, your healthcare agent or health care proxy, and your alternate health care proxy or healthcare agent. The changes in the new advance directive must be discussed with your primary physician, healthcare agent, family, and friends.

You can change your advance health care directive under the following situations. First, when you have a new diagnosis. Your new diagnosis in your medical record may require changes in your living will, which must be consulted with your primary physician first. Second is the change of marital status. The change of marital status may require you to select a new healthcare agent if your current healthcare proxy is your former spouse. Lastly, you can change your advance directive every ten years. This allows you to reflect and review from time to time if your current values and wishes are still the same as when you made your advance directive years ago.

What Should You Put In Advance Directive?

There are several things you should put in an advance directive. The first is the name and contact information of your healthcare proxy or healthcare agent. Your healthcare proxy or healthcare agent is the first person your medical doctors will contact in case of an emergency. This includes when your healthcare providers declare that you are incapable of making your own health care treatment decisions.

The next thing you need to provide is the answers to the questions about your medical care and treatment preferences once you are unable to make a health care decision for yourself. This includes the procedures and treatments you would like or would not like to receive. You can also include your preferences for care and values about end-of-life care and also the use of life-sustaining treatment and equipment.

Another thing to put in your advance directive is the names and signatures of the individuals who are witnesses to the signing of your advance directive form. The number of witnesses required depends on your state. Your state may also require your advance directive to be signed and sealed by a notary public.

For more information on an Advance Directive contact the team at Specialized Home Care today.