Advance Directives

Advance Directives, living wills and durable power of attorney.

Making end-of-life decisions about medical care can be difficult. An advance directive is a tool to help protect your medical wishes, instruct your physicians, and ease the stress on you and your family about making important decisions about your future.

NOTE: An advance directive is not a traditional will.

Types of Advance Directives

There are three types of advance directives:

Two of the documents are filled out by you with two witnesses verifying your signature. They are the Living Will and Healthcare Power-of-Attorney.  In Pennsylvania, neither need to be notarized, but if you travel, notarization may be needed in other states. 

Living Will:

Living wills are simply written instructions for what patients want if they are unable to speak for themselves in a medical crisis. To be valid, a living will must be a written document that is dated and signed by the patient and two witnesses. If the patient cannot physically sign, someone can act on the patient’s behalf in front of the two witnesses. In Pennsylvania, living wills do not have to be notarized, but in some states, they do. This is something people who travel a lot may want to consider.

Healthcare Power of Attorney:

Instead of having one’s wishes in writing, a person can make decisions on behalf of a patient as things happen. Adult patients can, at any time, appoint someone through a health-care power-of-attorney legal agreement.

The health-care power-of-attorney makes decisions when a person can no longer make decisions for themselves, as per the instructions of the power-of-attorney document. (Some people prefer to have a health-care power-of-attorney when they are competent, too, because they no longer want to make the decisions for themselves.)

Since the people are appointed while a patient is still competent, the people picked should know what the patient will want and how the patient feels about certain situations.

Download PA Advance Directive

 

The other document is POLST, and it is filled out by a medical professional when you have a life-threatening illness.

POLST: 

POLST, which is short for Pennsylvania order for life-sustaining treatment, is a bright pink form that is filled out by a patient’s healthcare professional - a doctor, physician assistant or nurse practitioner - only when someone is nearing end-of-life.

The form is brightly colored so it is easily recognizable as it travels with someone as he or she goes from home to a hospital or to a nursing home. The form is intended to provide clear communication for a patient’s preferences for end-of-life treatment across the range of settings.

POLST is not a form filled out by yourself or a family member. A living will or healthcare power-of-attorney form can be filled out at home and brought back to a doctor’s office or with you to the hospital. They are important, but they are not the same thing.

The POLST form is recommended for persons who are seriously ill with a life-limiting advanced illness or anyone of advanced age with a strong desire to further define their patient care wishes. It is not for people with stable medical or functionality problems who have many years of life expectancy. It is about current care not future care. The POLST is completed after discussion with a patient or their health care agent regarding their treatment preferences. By signing, the health care professional is assuming full responsibility for the medical indications of the orders and assuring they accurately reflect the person’s values. Patients have the right to have or limit treatments as they wish, and those wishes become medical orders that are to be followed. 

Changing Your Directive

You can change or cancel your advance directive at any time. Just be sure to notify family members, doctors and caregivers about any revisions and distribute updated copies of your form.

If You Do Not Have Directives

In Pennsylvania, if patients can not let their wishes be known about care and they are unable to communicate for themselves, the law determines who gets to make the decisions.

Not just any family member will be appointed if nothing is previously specified. The law requires hospitals to follow a specific order - no matter how close a person may be to the appointee.
They are:

  • Spouse and adult child who is not the child of the spouse
  • Adult child
  • Parent
  • Adult sibling
  • Adult grandchild
  • Close friend who knows the patient’s preferences and values

The law states that the person making the decision has to be reasonably available. If he or she is not, the next person on the list is contacted.

We cannot stress enough the importance of selecting a decision maker. Those who know us best should always be the first choice.

In Pennsylvania, if patients can not let their wishes be known about care and they are unable to communicate for themselves, the law determines who gets to make the decisions.

Not just any family member will be appointed if nothing is previously specified. The law requires hospitals to follow a specific order - no matter how close a person may be to the appointee. They are:
•  Spouse and adult child who is not the child of the spouse;
•  Adult child;
•  Parent;
•  Adult sibling;
•  Adult grandchild;
•  Close friend who knows the patient’s preferences and values.

The law states that the person making the decision has to be reasonably available. If he or she is not, the next person on the list is contacted.

We cannot stress enough the importance of selecting a decision maker. Those who know us best should always be the first choice.