Advance Directives:
High Stakes Word Games
ADVANCE DIRECTIVES are legal documents by which individuals express their wishes in case they ever become incapable of making health care decisions for themselves.
The laws governing these documents permit the withholding or withdrawal of life-sustaining treatment, including food and fluids, even when the intent is to directly cause death. Thus, the wrong kind of advance directive in the wrong hands can be a deadly combination.
Federal regulations require every health facility and program that receives Medicare and Medicaid funds to inform patients about advance directives. Many hospitals and nursing homes offer patients a directive to sign when they are being admitted and are probably under stress and distracted by other paperwork and questions. This is not an ideal circumstance for considering a legal document with life and death consequences. It is wise to arrive with your own carefully prepared directive in hand.
Living Will
A Living Will is an advance directive that includes details about the medical treatments you would and would not want to be used to keep you alive. This applies to any illness or injury you have in the future when you are unable to communicate your wishes to medical staff. The directions in a Living Will are either so vague as to be useless or so specific as to be hazardous.
A Living Will is downright dangerous. It gives an attending physician, very likely someone you do not know, the power to make life and death decisions for you based on their interpretation of the directions in your Living Will. Real medical crises often involve complicated medical and ethical questions that can’t be foreseen when filling out a form. Also, the directions you give in a Living Will, by law, must be followed. Therefore, you may tie the hands of a physician whose skills could restore you to health or save your life.
The Euthanasia Educational Council introduced the “Living Will” in the USA in 1967 and marketed it as a means to avoid suffering. Originally, living wills only covered refusal of “unwanted” treatment for imminently dying people. The euthanasia movement intended this “first step”—promoting the “right to die” via living wills—to evolve into medically imposed death.
POLST
Physician Orders for Life-Sustaining Treatment (POLST) is an advance directive used extensively throughout the United States. While the acronyms and wording of POLST forms may differ, they generally encourage patients to refuse life-saving treatments and care.
The POLST is a brightly colored form with check boxes next to options such as “do not attempt resuscitation,” “comfort interventions only” (another name for hospice), “no medically assisted nutrition/hydration,” etc. There are also options to select the kinds of treatment you do want, but they are just for show. At the top of every POLST form is the statement: “Any section not completed implies full treatment for that section.” Thus, you don’t need a POLST if you want treatment.
Once a POLST is filled out and signed by a doctor or other healthcare provider, it transforms into medical orders that can go into effect immediately, even if the patient is still able to make medical decisions. Any treatments or care refused in a POLST form will not be provided. This is the case even if they could be beneficial and help the patient recover. The POLST usually overrides other medical decisions, even if the patient did not sign it. This is unique. To be legally valid, every other advance directive requires the patient’s signature. A POLST is the only kind that requires a healthcare provider’s signature.
In most states, medical providers are excused from discipline, medical malpractice, or criminal charges as long as they follow the checkboxes on a POLST. They don’t have to make a diagnosis or discuss treatment options with you, your health care agent, or family.
The Wiser Choice: A Medical Power of Attorney
In a Medical Power of Attorney (MPA), you name a trusted person, usually a family member or friend, as your agent (a.k.a. proxy or surrogate) and instruct them on your wishes. Your agent can make medical decisions for you if you are unable to do so yourself, based on your values, current medical condition, and treatment options. See our magazine Informed for more information about lifesaving MPAs.
For more info on medical directives, check out HLA’s Informed: A Guide for Critical Medical Decisions.
Available at: humanlife.org, or visit our friends at Healthcare Advocacy and Leadership Organization: halovoice.org.