Health care decisions: Advance Directive/POLST
Who makes decisions about my health care?
Our health care community considers you — the patient — to be the primary decision maker. We strive to provide treatment that is consistent with your personal values and goals for quality of life. If there comes a time, however, when you cannot make decisions for yourself, your advance care plan will make your choices known to your family and health care providers.
As long as you are capable, you share in making major health care decisions, including the use of life-sustaining procedures.
If you become unconscious or incapable of making your own decisions, there are three written ways to make your preferences known in advance of a health care crisis:
- Oregon Advance Directive
- Physician Orders for Life-sustaining Treatment (POLST)
- Code Status
Why should I consider an advance care plan now?
- Making such decisions in advance allows you time to thoughtfully consider your options before a health care crisis occurs.
- It also allows time for discussion of your preferences and input from those you trust most when forming your decisions.
- Documenting your decisions in advance ensures that your choices will be the central focus of your health care, avoiding indecision and misunderstanding.
- Making such decisions for yourself gives peace of mind to your loved ones and health care providers, who can know for certain that they are following your wishes.
What decisions does an advance care plan cover?
- Any medical treatments you prefer to have or not have
- Any emergency efforts you do or do not want
- The appointment of a person to make decisions for you when you are unable to speak for yourself
When should I establish an advance care plan?
- Ideally, you should do it now, well in advance of a health care crisis.
- When you begin to make plans for the rest of your life, complete an Oregon Advance Directive. Most experts recommend that you have one by age 60.
- When you know you have a serious or chronic illness, ask your physician to help you fill out a POLST form.
- If you enter a hospital with a condition that might result in your heart or breathing stopping, you and your physician will discuss your preferences and determine your Code Status.
What documents may be used to create an advance care plan?
There are three current documents involved in advance care planning. Any or all of the following may be used.
Advance Directive
- Long and detailed “living will” of your values and preferences for treatment if you become unable to speak for yourself
- Allows the legal appointment of a health care representative
- Remains in effect until revised or revoked by you
POLST
- Four short, specific physician orders that you and your health care provider have discussed (written by your physician, nurse practitioner or physician’s assistant), giving clear direction to all caregivers that reflect your choices for life-sustaining treatments
- Valid at your home and in all inpatient and outpatient settings
- Will be entered into statewide electronic registry for access by any medical providers in Oregon
- Remains in effect until revised or revoked by you
Code Status
- Specific orders about resuscitation written at the hospital by your admitting physician
- Applies only if your heart stops or you stop breathing
- Applies only during the current hospitalization
What happens if I don’t have an advance care plan?
Unless you have documentation of your wishes to the contrary, health care providers are required by protocol to use the most aggressive interventions available in a medical emergency. These include:
- Electrical shock to your heart
- Cardiopulmonary resuscitation (CPR): vigorous compressions of your rib cage
- Life-support machines to help you breathe
- Tube feeding to provide nutrition/hydration
- Intensive care
Remember: Your wishes can be honored only if they are known!
How do I create my advance care plan?
- Begin a conversation with your family, your primary care physician or health care provider to discuss your end of life wishes.
- While at the hospital, you may ask patient relations, a social worker, a chaplain or the nursing supervisor for assistance.
- You may also watch a video on the hospital’s closed circuit TV. Advance Directive: channel 909; POLST in English: channel 917; in Spanish: 916; POLST registry: channel 919.
Additional information can be found online at:
Advance Directive:
www.caringinfo.orgPOLST:
https://oregonpolst.org/patients-family
When do I share my Advance Directive/POLST?
Every time you seek care at a health care facility, please bring a copy of your most current Advance Directive and/or POLST with you to ensure that it is included in your medical record or the Oregon POLST registry. Carry a wallet card indicating that you have a POLST or Advance Directive. Some wallet cards also contain a summary of your four choices (POLST). These are made available from patient relations.
What medical programs might you consider in advanced care planning?
About palliative care and hospice care:
Palliative care is provided by a multi-specialty treatment team for patients with a serious illness to relieve suffering. Its goal is to maximize quality of life while living with a serious illness and its treatments, regardless if cure is or is not possible. Palliative care provides physical, psycho-social and spiritual support, and is delivered alongside both life-prolonging treatments and end-of-life care.
Asante offers an in-hospital palliative care program. Services include:
- Pain and symptom management related to serious illness and its treatments
- Collaboration with your current doctors to maximize quality of life
- Emotional and spiritual support to patient, family, caregivers and staff
- Guidance with complex treatment choices, advance care planning and goal setting
The Asante Palliative Care team can be reached at (541) 789-4352.
Additional information on palliative care can be found at:
www.palliativedoctors.org
www.caringinfo.org
www.capc.org
Hospice care is comfort care for patients in the last six months of life. The focus of care is on pain control, and support for the best quality of life for patients and their families. Hospice honors patients' choices for comfort, dignity, personal control and quality of life in their home or familiar surrounding. Hospice is indicated when a cure is no longer possible and the burden of treatment is greater than the benefits. Hospice includes:
- Focus on comfort, personal control, dignity and quality of life
- Support and training to family and caregivers
- Pain and symptom management at end of life
- Care given at home or at care facilities
- On-call support 24 hours a day, seven days a week.
Asante Hospice can be reached at (541) 789-5005.
Additional information on hospice care can be found at:
www.oregonhospice.org
www.nhpco.org
www.hospicefoundation.org
