Advance Medical Directives: Living Will, Medical Orders (MOLST & POLST), DNR
by ACTEC Fellows Daniel G. Fish and Tara Anne Pleat
Advance directives are documents that express an individual’s health care wishes. ACTEC Fellows Daniel G. Fish and Tara Anne Pleat define and discuss end-of-life advance medical directives including a Living Will, Healthcare Proxy, medical orders (MOLST & POLST), and Do Not Resuscitate (DNR) orders.
Welcome. My name is Daniel Fish. I’m a Fellow with ACTEC from New York. With me today is Tara Pleat from New York as well. She is an ACTEC Fellow, and we’re here today to talk about advance directives. Tara, can you help us out and start defining for us what advance directives are?
Sure. “Advance directives” is a general term to describe primarily two documents that allow an individual to express what their health care wishes might be if they were in a circumstance where they were not able to voice those wishes themselves. Typically, they’re referred to as a “healthcare proxy” or a “durable health care power of attorney,” depending upon what state you’re living in, and a “living will document.”
And, can you tell us the difference between those documents?
Sure. A living will document is a document that states a patient’s preferences for different types of treatment in different circumstances; and typically, it is addressing end-of-life type circumstance. So, if a person is in a persistent vegetative state or they’ve been given a terminal diagnosis and there is an anticipation that they may reach a point where they can’t make their own decision, they’re expressing whether or not they might want life-sustaining treatment or if they would want life-sustaining treatment withheld or withdrawn through that document. The healthcare proxy or durable health care power of attorney is the document where you are appointing an agent to say this is the person who is going to be empowered to voice decisions for me if I’m incapable of voicing them myself.
And who can make these advance directives?
Generally, anybody over the age of 18 who has not been declared incompetent by a court in their state.
And how long do they last?
They last forever unless the patient has put an expiration date or a particular timeframe in the document; but otherwise, they exist until they’re revoked or the patient passes away.
Can you tell us – there are other documents called a MOLST and a POLST- can you tell us what those are?
Sure. MOLST and POLST are two acronyms defining medical orders. The MOLST is the Medical Orders for Life-Sustaining Treatment and the POLST is the Physician Orders for Life-Sustaining Treatment. They’re both the same thing, but in different states they call them by those two different names. But, as I’ve said now twice, they are orders. They are documents that were generated in an effort to have a patient have the ability to have a conversation with their doctor about a particular affliction, and whether or not they would want intubation, resuscitation, antibiotic treatment, as opposed to living will documents, which are drafted by you and I. And we are not doctors. So, we have academic discussions often with our clients about what an end-of-life circumstance might be, but the POLST and the MOLST give a patient the opportunity to have a real-life conversation with their health care provider. And that POLST or MOLST is an order. So, it gets entered into the patient’s chart and it’s followed in the health care setting.
And what is a DNR?
A DNR is a Do Not Resuscitate order. And you might find we have clients, that think that they’ve signed them, not understanding that Do Not Resuscitate orders really are also medical orders. And they’re entered into a patient’s chart by their doctor. If they’re in a hospital, it’s a hospital DNR, and if they’re outside of a hospital, a non-hospital DNR for EMT type purposes. But, what the Do Not Resuscitate order is, is an order not to provide CPR if a person goes into cardiac arrest, in whatever circumstance they may be in.
And what should a person do with these advance directives after they’ve signed them?
Well, in our practice we advise our clients to give copies to any primary care physician that they see and any specialist they see with any frequency. In addition, your clients should be giving copies of these documents to the agents that they appoint; and sometimes our clients will be hesitant to do that and we kind of want them to be having conversations with the people that they’re appointing. If you’re going to give someone the responsibility to potentially make an end-of-life decision, they need to know it and you, as the patient, need to understand that that person is going to be willing to carry out your wishes. So, presuming we’ve gotten through that conversation with our clients, we’re telling them they should be giving copies to their agents as well.
Excellent. Thank you so much, Tara. I appreciate it.
Thank you, Dan.