Health Care Decision Making: From Basic to Advanced

Estate planning is much more than just directing how your assets should be distributed after your death. An equally important aspect of estate planning is making sure that you have planned for situations during your life where you may not be able to make decisions for yourself.

Today, we are going to give you a quick breakdown of some of the documents available to plan for your health care decision making if you are unable to make those decisions on your own.

AHCD

• What it is: AHCD stands for “Advance Health Care Directive.”
• Who needs one: Every person age 18+, healthy or not. An AHCD is prepared as part of all estate plans.
  
  
• What it does:
  • Designates an agent to make decisions for you if you can’t.
  • Specifies your preferences for end of life treatment, organ donation, and any other specific wishes you want your agent and providers to know when making health care decisions for you.
  • We also include burial or cremation instructions because it is your health care agent that has the authority to dispose of remains under California law.
    
    
• Why is an AHCD needed: takes the guesswork out of who should make decisions within specified guidelines.
  • YOU get to pick who makes health care decisions. Without an AHCD, hospital staff default to “next of kin.” This person may not be the one you would have wanted to make your decisions.
  • YOU get to specify what type of treatment you want. Help guide your family in a time of distress by eliminating some of the burden in decision making.

DNR

• What it is: DNR stands for “Do Not Resuscitate.” This is a form that must be signed by a patient and doctor.
• What it does: Emergency medical professionals are required to resuscitate if a patient is found not breathing/heart is not beating. With a DNR, EMS will not perform CPR.
• Who needs one: any person who is concerned that the risks of CPR outweigh benefits.
• Why is a DNR needed: without one, EMS must perform CPR. EMS cannot follow AHCD provisions in emergency situations.

POLST

• What it is: POLST stands for “Physician Orders for Life-Sustaining Treatment.” Signed by patient and doctor following a thorough discussion of patient’s wishes.
  
  
• What it does: It is a medical order intended to compliment the AHCD.
  • Does patient want CPR? Serves similar function as DNR form.
  • Provides for specific medical interventions to be taken if patient has pulse and/or is breathing. Does patient want full treatment (i.e., prolong life by all medically effective means), selective treatment, or comfort-focused treatment?
  • Artificially Administered Nutrition. Does the patient want a feeding tube? Under what circumstances?
    
    
• Who needs one: Anyone can complete, healthy or not. However, a POLST is usually completed by a seriously ill individual whose provider believes he/she may have less than one year to live.
  
  
• Why is a POLST needed: as a medical order, reduces doubt and challenges in decision making. An AHCD is still needed, since the POLST does not specify who should make decisions not specified on the form.