last article discussed the power of attorney for personal care. That article discussed how to authorize an
agent to handle financial and property issues largely related to your personal
care. This article discusses how to make
your health care wishes enforceable. The
Advance Health Care Directive, the Do-Not-Resuscitate Order, and the Physicians
Order for Life Sustaining Treatment are the primary documents to be aware of. Let’s examine them.
Advance Health Care Directive (“AHCD”) has two primary purposes: first, to express
your health care wishes; and second, to authorize a health care agent to make
medical decisions on your behalf only when you become incapacitated. For example, whether or not to receive heroic
life-sustaining treatment when in an irreversible vegetative state; whether or
not to receive pain killing medicine if terminally ill even if it hastens an
inevitable death; and whether or not to donate organs. But the directive can also say who should be
allowed to visit you while you are in hospital; what kind of human contact you
want to be allowed; and how your funeral should be conducted. Your AHCD agent will have access to your
confidential health care information and be authorized to make decisions on
your behalf consistent with the wishes you express in you directive.
printed AHCD forms are available. The
California Medical Association (“CMA”) form is widely used and recognized by
California hospitals. It can be ordered
by phone at (800) 882-1262 or online at http://www.cmanet.org. California also has its own version of the
health care directive, however, cannot by itself prevent emergency responders
from administering life support such as cardiopulmonary resuscitation (CPR). For persons who do not wish to have CPR and who
wish to allow a natural death to occur, it is necessary to have either a “do
not resuscitate” (DNR) form or a “physician’s order for life sustaining treatment”
The Emergency Medical
Services (“EMS”) DNR form issued by the CMA is the older approach. A DNR form must be signed by the physician
and the patient. A Medic-Alert bracelet
should also be obtained and worn at all times so that emergency responders can
immediately identify the person’s DNR status.
DNR forms require consultation with a physician and a physician’s
The more recent two page
POLST form is much broader than the DNR form.
Like the DNR form it requires a consultation with a physician. Unlike the DNR form, which serves only to say,
“no CPR”, the POLST form requires a broad discussion with the physician regarding the
degree to which medical treatment should be given on a wide range of issues: resuscitation, medical conditions, use of
antibiotics, artificial nutrition, and other life sustaining treatments. For example, the POLST form can be used to authorize
that CPR be performed to restore one to a worthwhile condition of health, but
otherwise to forego CPR. POLST forms
are signed by the physician and the patient, and are a doctor’s order. The POLST form is intended for a person who
has a serious illness. It should
accompany you wherever you go at all times.
California’s POLST is printed on bright pink stationary, but it can be
printed on white paper too. For more
information regarding the POLST visit, “www.capolst.org”.
The POLST form,
however, does not replace the AHCD. Only
the AHCD allows you to authorize an agent to make health care decisions for you
and to express your wishes regarding organ donation, funeral arrangements, and
other concerns. Everyone should have an