End of Life Decisions – What Are All These Documents?


January 19, 2024

Between the bright pink form doctors provide their patients with and the obsolete reference to a “living will” we often hear, many of our clients are rightfully confused about the different documents that govern in medical emergencies or end-of-life decisions.  We hope the following overview will provide clarity.

In your Advance Health Care Directive (“AHCD”), you appoint an agent to make medical decisions for you if you are unable to make those decisions yourself. Your agent stands in your shoes and makes all medical decisions, guided by the preferences you indicate in the document, that you would make if you were able. In the document you specify which treatments you want performed (or not performed), and under what circumstances, and when you would like life-sustaining care withheld or removed. You may also state your post-death preferences about autopsy, disposition of remains, organ donation and memorial services.  If you only want your preferences on these matters made known, you can sign an AHCD without appointing an agent.  You should provide a copy of your AHCD to your physician for your medical file.  Many years ago, this document was called a “living will.”  This term is still in common usage, so if you hear it, know that it is the AHCD that is being referred to.

By law, emergency medical professionals are required to administer life-sustaining treatments, like CPR, to you. These professionals are acting in the moment to save your life, so your AHCD typically will not come into play. The AHCD will be considered when you are hospitalized and decisions need to be made about starting or withdrawing treatment; at this point, the doctor will seek direction from the agent under your AHCD. Fortunately, there are documents you can sign, in addition to the AHCD, if you wish to avoid resuscitation efforts in an emergency, such as a POLST or DNR.

Unlike an AHCD, a Physician’s Order for Life-Sustaining Treatment (“POLST”) requires a physician’s signature in addition to your signature.  A POLST translates the broad treatment wishes outlined in an AHCD into specific medical orders. It details your desire to avoid resuscitation efforts in an emergency and also states your intention to decline life-sustaining treatments, such as intubation. A POLST is always printed on bright pink paper so it can be found easily in an emergency. If circumstances allow, emergency first responders will look for a POLST on your refrigerator door or in your medicine cabinet.

A Do Not Resuscitate Order (“DNR”), like a POLST, is a medical order that must be signed by a physician, but it only instructs emergency medical professionals to withhold resuscitation efforts if your heart stops beating or you stop breathing. A DNR applies in this limited scenario while a POLST applies to a wider range of scenarios. If you have a DNR, you should keep it in your home in plain sight, so emergency first responders will easily see it upon arrival at your home.

While we will discuss these documents with you as part of the estate planning process, we recommend that you speak with your doctor as well.  Your doctor knows your current medical status and can provide detailed guidance about any specific health care considerations.

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