Durable Power of Attorney for Health Care( DPOA-HC)
The Durable Power of Attorney for Health Care is a signed legal document that designates and authorizes an agent to carry out a person’ s healthcare and life-support wishes at any time in the future that one loses the ability to speak or make one’ s own decisions. Every state in the United States has passed a state law recognizing Durable Power of Attorney for Health Care. However, certain regulations may differ from state to state, such as whether a notary is required.
In addition to naming a healthcare agent, the person who is establishing a DPOA-HC also identifies alternate or successor agents who will serve— one at a time, and in listed order— if the original agent can no longer function in the role. A DPOA-HC can include instructions regarding life-support measures, artificial nutrition( tube feeding and what type) and hydration( intravenous fluids), mechanical ventilation( tracheotomy), comfort care, if or when to end life-sustaining measures, CPR, anatomical organ gifts, and disposal of remains. It is crucial that anyone who is completing a DPOA-HC discusses their wishes with their chosen agent and successor( s). If those people indicate that they would not be comfortable expressing your personal wishes, then you need to choose another agent, or successor, as the case may be. If the time comes that your designated agent is unsure of your wishes in a specific situation, that agent is required to speak in your“ best interest.”
Remember to periodically review, update( if necessary), re-date, and initial the original document.
DPOA-HCs can be ended any time by informing your physician and agent of your decision and destroying the document, or by drafting, signing, and dating a new one.
Practitioner Orders for Life-Sustaining Treatment( POLST) or Medical Orders for Life-Sustaining Treatment( MOLST) POLSTs are signed practitioner’ s orders. They act as standing medical orders and apply to all healthcare personnel( EMTs, emergency room personnel, etc.) and in all settings( homes, assisted living facilities, nursing homes, etc.). The type of practitioners who can sign the POLST varies by state, and may include a physician, advance practice registered nurse, nurse practitioner, and physician assistant. POLSTs provide guidance about one’ s care near the end of life, allowing healthcare personnel to act immediately— and in line with your wishes— in an emergency. POLSTs spell out what specific care should be administered or withheld at the present moment in time for a specific patient, as directed by a physician. The POLST Paradigm is in effect in most states of the United States.
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Because these are signed medical orders, they are portable in states where POLST programs have been legislatively determined. This means that all healthcare facilities and emergency service providers in the region have agreed to recognize and abide by the orders, regardless of where the document was originally signed. POLST is particularly relevant to patients expected to transition from one healthcare setting to another.
The form is completed after a careful discussion between the doctor and all parties involved. The form contains three sections: cardiopulmonary resuscitation, medical interventions, and artificially administered nutrition. The patient can choose no nutrition by tube, defined trial period of tube nutrition, or long-term artificial nutrition by tube.
For more information, please see the POLST website: www. polst. org.