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Advance Directive & POLST

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All adults should have an Advance Directive. The purpose of the Advance Directive is twofold:

  1. To designate a healthcare representative who will make decisions about your care when you can’t, and
  2. To give instructions to your representative regarding your wishes in various circumstances.

Please note that while an Advance Directive is recommended, it is not required in order to enroll in hospice.

POLST forms address key issues relating to emergency or acute treatment:

  1. Whether you would want to be resuscitated with CPR if you are not breathing and have no pulse;
  2. If you are breathing and have a pulse, but are not able to communicate how much treatment you want: comfort, limited or full.

This information is specifically intended for Emergency Medical Technicians arriving at your home after a 911 call, or hospital staff. EMTs cannot be guided by what is in your Advance Directive – only by your POLST form. If you are in frail health and likely to have an emergency situation, it is a good idea not only to fill out a POLST but to have it in a place that is readily accessible, like your fridge. There is an online POLST registry that EMTs check, but this takes time and may not be 100% reliable.

Please note that while a POLST is recommended, it is not required in order to enroll in hospice.

The document is legal until you revoke or change it. Importantly, your representative can only make decisions on your behalf while you are incapacitated – not while you are able to make your own decisions.

Often people think of a family member first. While this may be the right choice, there are circumstances where it could be better to choose a close friend – such as:

  • Your family member lives some distance away (time zone or travel time issues). Particularly in the hospital setting, decisions are made quickly and real time input may be critical.
  • Your family member does not fully agree with the decisions you have made, or would have emotional difficulty adhering to them. Although there is a section in the document that states whether your decisions should be followed specifically or as guidance, these definitions have “grey areas” under real world circumstances.
  • Your designated family member is the primary beneficiary of your estate. It may be best to separate financial from personal health decision-making in this situation.

The most important part of making the decisions in the Advance Directive is talking about them with people you respect and care about, including your representative. Discussions help clarify your wishes and the reasons why you made them. The form is not valid without the signature of your representative, and after they have signed, you still need signatures from either two witnesses OR a notary before it becomes official. The witnesses can be anyone EXCEPT your health care provider OR your healthcare representative.

Question/Purpose
POLST
Advance Directive
Who should have one?
People who are likely to have a health emergency due to illness or age
Any person 18 and older
What does it do?
Provides specific orders regarding treatments that you want, that must be followed by other emergency and medical staff

This is a MEDICAL ORDER

Provides basic guidance about your goals and wishes for future treatment

This is a LEGAL FORM

Can this form be used to identify a decision maker if I am unable to make decisions about my health?
No
Yes
Who signs this form?
You and your medical provider
You and 2 other adult witnesses (who must not be involved in your medical care or your decision maker)

OR

You and a notary

Can I alter this document if I change my mind?
Yes, you and your doctor can change the POLST at any time
Yes, you can make any changes at any time
Where can I go to learn more information?
Oregon POLST | The Founding Program
Oregon Health Authority : Advance Directive Forms : About the Public Health Division : State of Oregon

Download the Advance Directive Form

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