The Advance Health Care Directive
In health and nursing care, much attention is paid to understanding and learning advanced directives (ADs) that are the legal documents for medical decision-making. Regarding multiple changes in health and medicine fields and the impact of cultural and religious beliefs on care choices, the need to develop advanced care plans increases to support patients and protect the care staff (Scholten et al., 2018). In this paper, I use the California state AD that I obtained on the National Hospice and Palliative Care Organization site. It complies with the state law of California, as ADs are established in the Uniform Health Care Decisions Act.
According to the form, ADs are legally binding if they are signed by competent adults older than 18 years, before a notary public or two adults (not healthcare providers or blood-related) (National Hospice and Palliative Care Organization, 2020). In the chosen state, it is legally approved to choose a competent individual to make healthcare decisions under specific circumstances (a power of attorney).
It is not always easy for people to plan how to receive care when no decisions can be made independently. However, this document works well to protect human lives and follow the principles of respect and dignity. There are five main sections to be filled in and signed. First, an attorney is chosen, and it is possible to choose two more alternative agents, optionally. Then, the instructions either to prolong life or not medically are given. The third part is about organ donation and the possibility to share the body for therapeutic or educational purposes. The responsibilities of a physician are discussed in the fourth section, and all signatures and witnessing details are in the last fifth part.
Not all family members are ready to accept the decisions of patients, and some people suffer physically or emotionally from undesired care. Scholten et al. (2018) admit that ADs alleviate suffering, improve the quality of life by supporting reasonable decisions, and control healthcare costs. At the same time, patients usually feel ambivalent about signing ADs because they try to choose their best care options but cannot manage negative thoughts (Otte et al., 2018). Therefore, they need general practitioner’s assistance and professional counseling.
Physician Orders for Life-Sustaining Treatment (POLST) Form
Californian citizens have several approaches to identifying the quality and methods of their life-sustaining care. The Physician Orders for Life-Sustaining Treatment (POLST) form is one of the options. It was implemented in California in 2009 to facilitate the transition of care preferences into physical orders in special settings (Jennings et al., 2016). Assisted living facilities and nursing homes suggest their clients to consider POLST forms, but this requirement remains voluntary and only for people who are seriously ill. There are four main sections in this document: cardiopulmonary resuscitation, medical interventions, artificially administrated nutrition, and signatures. (Coalition for Compassionate Care of California, 2020).
California law provides immunity to people, who are in good faith, and a POLST form is never obligatory but recommended (Coalition for Compassionate Care of California, 2020). One should remember that a POLST is not used to replace an AD but works together with this document to provide more details about care at the end of life. Its purpose is to create an effective framework for healthcare providers to develop treatment plans as per patients’ wishes.
It is necessary to admit that POLST forms are completed by physicians only, and patients are never given these documents to fill in. A physician communicates with a patient, explain all crucial details, and focus on all unclear medical terms. If a patient is not able to listen to the required information, an attorney takes responsibility as per the conditions defined in the AD. However, in any situation, a physician is responsible for informing the patient or a legal representative about possible consequences and rules and completing the form, using the patient’s personal information.
There are three main conditions under which a POLST has to be reviewed and completed: transferring from another care setting, change of treatment preferences, and change of the health status. Braun (2016) defines POLST forms as binding orders that translate a discussion between a patient and a physician. Some states do not require the signatures of patients, and the physicians’ ones are enough (Braun, 2016). In California, POLST forms must be signed by both a patient (a designed agent) and a physician and saved along with a copy of medical records.
When people face the challenge of end-of-life care, healthcare facilities have to consider their patients’ interests, family needs, and legal issues. In many American hospitals, nursing homes, and clinics, such documents as ADs and POLTS forms are used for care planning and communication with patients. POLTS forms and Ads cannot substitute each other due to their characteristics and goals. For example, an AD has to be filled in and signed by a patient only and requires the presence of a notary representative and other responsible adults. In case of POLTS completion, a patient cannot touch the form, and all information has to be added by a physician.
The patient should only leave his/her signature nearby the signature of the physician. Another difference between these documents is the need for counseling and extra help. When patients complete their ADs, they do not ask for additional help, and all their decisions must be independent. However, POLTS forms include medical terms, and some information remains unclear to ordinary patients with no medical education. Therefore, the participation and explanations of physicians are recommended for the POLST.
One of the main purposes that unites the POLST and an AD in California is the promotion of patients’ autonomy in healthcare settings. The autonomy concept was frequently discussed during the last several decades, and it is now concluded that nurses, as well as other care staff, have to respect patients and enhance their health and autonomy. Registered nurses contribute to an understanding of medical information by patients and their families.
It is not enough to explain the nature of a disease or the importance of treatment and medications but to support them in decision-making. In the United States, autonomy is respected, but some European and Asian countries question this necessity. Healthcare interventions depend on patients’ conditions, needs, resources, and even religious or cultural beliefs. If a person does not want to receive care or a particular medication, a healthcare provider should gather information and define if such a request should be taken into account. In the majority of cases, care providers ask if the patient has already completed the POLST and if he/she has an AD. These two documents help understand what kind of care people expect to get.
Braun, U. K. (2016). Experiences with POLST: Opportunities for improving advance care planning. Journal of General Internal Medicine, 31(10), 1111-1112. Web.
Coalition for Compassionate Care of California. (2020). What is a POLST? . Web.
Jennings, L. A., Zingmond, D., Louie, R., Tseng, C. H., Thomas, J., O’Malley, K., & Wenger, N. S. (2016). Use of the physician orders for life-sustaining treatment among California nursing home residents. Journal of General Internal Medicine, 31(10), 1119-1126. Web.
National Hospice and Palliative Care Organization. (2020). California advance directive: Planning for important health care decisions. Web.
Otte, I. C., Elger, B., Jung, C., & Bally, K. W. (2016). The utility of standardized advance directives: The general practitioners’ perspective. Medicine, Health Care and Philosophy, 19(2), 199-206. Web.
Scholten, G., Bourguignon, S., Delanote, A., Vermeulen, B., Van Boxem, G., & Schoenmakers, B. (2018). Advance directive: Does the GP know and address what the patient wants? Advance directive in primary care. BMC Medical Ethics, 19. Web.