A Health Care Directive, an Advance Directive and a Living Will are the same thing, a document where you state your health care wishes if you are at end of life. The term “Living Will” is confusing as it bears no relationship to a Last Will and Testament. To avoid confusion we will only use the term “Advance Directive.”
An Advance Directive refers to a legal document in which you specify in writing your wishes regarding your health care should you be at end of life or in a permanent vegetative condition and unable to communicate your wishes. It is critical that you make your health care wishes known through your Health Care Directive.
The Advance Directive is an important document that works with your Durable Power Of Attorney for Health Care Decisions to empower your Attorney-in-Fact to confidently carry out your wishes.
What Is Included in An Advance Directive?
An Advance Directive provides specific direction to health care providers about the types of treatments you do or do not want. Some people choose not to have various kinds of medical treatment, while others choose to have certain medical treatments or all available medical options (pain relief, resuscitation, artificial nutrition/hydration, intubation or mechanical intervention, such as a ventilator, dialysis, provision of antibiotics, etc.). It is your choice as to whether you want your life prolonged or if you want to be permitted to die naturally.
The Advance Directive is referred to by your health care provider if you have a terminal condition or are in an irreversible coma or other permanent unconscious condition and there is no reasonable hope of recovery. The Advance Directive must be signed by you and two witnesses who are not related to you, who will not inherit anything from you and who are not individuals providing health care services to you.
It is important to let your physicians and loved ones know what your wishes for treatment would be should you face a terminal illness or permanent vegetative condition. Medical facilities may assume you want all available medical treatment, including life-sustaining care, unless you direct otherwise. Your Advance Directive, together with your Health Care Agent’s direction authorized under your Durable Power Of Attorney for Health Care will ensure that your wishes are honored, whatever they may be.
Your Advance Directive may include provisions such as:
- Refusing all medical care
- Removing life support in the event of a permanent vegetative state or terminal condition
- Instructions to use all efforts to sustain life, no matter the circumstances
- Specifying a time period to remain on life support or to withdraw it
- Religious considerations such as refusal of blood products or transfusions
What Is a POLST?
A POLST is a Physician Order for Life Sustaining Treatment. It is a document that tells emergency responders and physicians what to do in an emergency.
For individuals with serious health conditions who are in the final stage of life, or suffering from an advanced stage terminal illness or illness from which they are not expected to recover, a Physicians Order for Life Sustaining Treatment (POLST) form is available.
Idaho’s form is called a Physician Orders for Scope of Treatment (POST)
POLST forms allow individuals to summarize their wishes regarding end-of-life treatment. The POLST is complementary to the Advance Directive but does not replace it. A POLST form is a medical order, signed by you and your physician, which outlines specific medical orders to be honored by health care workers during a medical crisis. The POLST is a brightly colored form (often green) which is immediately recognizable and can be used by doctors and first responders (including paramedics, fire departments, police, emergency rooms, hospitals and nursing homes). POLST forms are usually recommended by physicians for those individuals who no longer wish to be resuscitated so that they may die naturally. A POLST form is usually posted on a refrigerator or other conspicuous place where it will be seen by first responders.
Do I Need Both an Advance Directive and A Durable Power Of Attorney for Health Care?
Yes! Having both an Advance Directive and a Durable Power Of Attorney for Health Care will provide the best protection for your treatment wishes and comprehensive guidance regarding your care.
Making your wishes known in an Advance Directive will provide your doctor and your Health Care Agent the clear guidance necessary to carry out your wishes.
What Is the Washington Death with Dignity Act? Can My Health Care Agent Make Choices for Me Under the Act?
Washington is one of just a few states in the United States that allows an individual who meets residency and medical diagnosis requirements to request lethal doses of medication which will hasten end-of-life. The Washington Death with Dignity Act, Initiative 1000, codified as RCW 70.245, passed on November 4, 2008, and went into effect on March 5, 2009. This act allows terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians. These terminally ill patients must be Washington residents who have less than six months to live.
The Act contains many protections to ensure that the person is competent, acting voluntarily, and making an informed decision. This means that your Health Care Agent cannot make this choice on your behalf. You must be competent and request the medication for yourself.
What Is the Difference Between an Advance Directive and Power Of Attorney for Health Care?
An Advance Directive is different than a Durable Power Of Attorney for Health Care. A Durable Power Of Attorney for Health Care is the legal document through which you appoint a Health Care Agent to speak for you. Not uncommonly an Advance Directive is combined with the Durable Power Of Attorney for Health Care, providing all information about your health care wishes and who is authorized to speak for you in one document.
In every State, you have the right to make your own health care decisions. Under the principle of “informed consent,” your medical care must be explained so you understand it and can make informed decisions. (Treatment without consent, however, is allowed and will generally be provided in an emergency unless you indicate otherwise). If you are not able to understand your medical treatment options, your Health Care Agent will speak for you based on your wishes as stated in your Advance Directive.