Life care planning for yourself or for an aging parent or grandparent can feel complicated, but it does not need to be confusing. Understanding the similarities and differences between key medical and legal documents, as well as how they interact with each other in practice, will set you up to ensure you or your loved one’s wishes are properly communicated to and respected by health care providers when needed. This article will explain the differences between commonly confused legal and medical documents related to end-of-life planning, including advance directives, living wills, DNRs, and POLSTs.
What are advance directives?
“Advance directive” is an umbrella term referring to various types of legal documents that specify a patient’s wishes regarding medical care in emergency or end-of-life care situations when they cannot communicate directly with their health care provider. Each state has different terms for the different types of advance directives, but they generally consist of:
- A power of attorney for health care.
- A living will.
- A do-not-resuscitate (DNR) order.
- Physician orders for life-sustaining treatment (POLST).
Each type of advance directive functions a little differently from the others, and all can be used together to give a health care provider a complete picture of a patient’s medical wishes.
Advance directives are most commonly used when one has been diagnosed with a terminal illness, such as cancer or Alzheimer’s disease, or in the case of a chronic condition where someone may be incapacitated at various and unpredictable times in their life.
However, even if you are young and healthy, you may be asked during a routine exam whether you have an advance directive as part of regular screening, as health care providers can provide you with resources if you would like to create one.
Advance directives can be revoked at any time by the patient if they have the capacity to do so. They can be revoked verbally, in writing, or by creating an updated advance directive. Advance directives do not expire, so it is recommended that they be reviewed every few years or in the event of a change in health status.
It is also important to know that each state has its own versions and requirements for advance directives, and advance directives are not always recognized from one state to another. When creating an advance directive, you should check with your state law to ensure you are completing the document properly.
Are health care providers required to follow advance directives?
While advance directives are almost always followed by health care providers, they are not required by law to follow advance directives if the provider finds the orders medically inappropriate or against their conscience. For example, if you have an order prohibiting a doctor from performing CPR while you are in cardiac arrest, but the doctor determines your cardiac arrest is due to a reversible medical error such as taking the wrong medication, the doctor can override your advance directive.
Let’s take a closer look at the different types of advance directives.
Health care power of attorney
A power of attorney for health care (also called a health care proxy or medical power of attorney, depending on the state) is a legal document that allows you to appoint another person to make medical decisions on your behalf if you become unable to communicate or make decisions for yourself. This designated individual, known as your agent or surrogate, can speak with your doctors, review your medical information, and authorize or decline treatments based on your expressed wishes.
A power of attorney for health care focuses on who can make decisions rather than what those decisions must be. This makes it especially important in situations that cannot be anticipated in advance. Your agent can ensure that your medical care aligns with your wishes when you cannot advocate for yourself.
Living will
A living will is a document that tells health care providers generally what life-prolonging procedures the patient consents to or does not consent to having. A living will does not designate an individual to make the decision for you, but if you have a health care power of attorney, that person can help enforce your living will if you are incapacitated. It also is not a medical order but rather offers general guidance about your wishes for life-sustaining interventions.
A living will form will typically look like a questionnaire that asks whether you do or do not consent to certain types of treatment such as mechanical ventilation, CPR, or tube feeding. It can also ask about your preferences for organ or tissue donation after you die.
Physician orders for life-sustaining treatment (POLST)
Physician orders for life-sustaining treatment (POLST) forms, also called medical orders for life-sustaining treatment (MOLST) forms, are similar to living wills, but rather than giving general consent to treatment for a terminal illness, they list specific medical orders that health care providers must follow during a medical emergency. In other words, it is more specific about the types of treatment a patient would want in a particular medical situation, based on their diagnosis and condition. It is much more detailed and situational than a living will and is intended for patients whose current health condition makes certain medical decisions foreseeable.
For example, on a standard POLST form, you may check a box that states that in the event you have no pulse or are not breathing, the health care providers must attempt to resuscitate you. You may also specify when to use certain antibiotics or receive a blood transfusion.
Do-not-resuscitate (DNR) order
A DNR order is a medical order that specifically tells health care providers not to use CPR to resuscitate the patient during a medical emergency. A DNR order can be given by the patient if they are able to make medical decisions; otherwise a health care power of attorney may make the decision for the patient.
A living will and DNR are typically not valid in out-of-hospital situations. What this means is that if you are experiencing a medical emergency in your home or other non-hospital setting and have a DNR, emergency medical services (EMS) will still provide you with CPR. If you do not want EMS to provide CPR in a non-hospital setting, you can declare this in the POLST form, which is the only document EMS is required to follow in most states.
Planning for future medical care can feel overwhelming, but understanding the purpose and limitations of each type of advance directive can help you make informed choices for yourself or a loved one. In clearly documenting your wishes, you give health care providers and family members the guidance they need to honor your wishes during critical moments. Taking the time to create or review these documents now ensures that your preferences are respected and that those supporting you can act with clarity and confidence when it matters most.
This information is for educational purposes and is not legal, financial, tax, or investment advice. It should not be substituted for information from professionals authorized to practice in your area. You should always consult a suitably qualified professional regarding your specific situation.
