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What You Should Know About Advance Directives

A primer on healthcare proxies, MOLST and living wills.
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What You Should Know About Advance Directives
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What You Should Know About Advance Directives

With the passage of the Family Health Care Decisions Act and the Palliative Care Information Act in New York, there has been an increase in awareness of the importance of advance directives.

Marcie S. Gitlin, LMSW at Jewish Home Lifecare, Bronx Division offers the following tips on the basic things individuals should know when it comes to completing advance directives:

  • Advance directives are documents authorized and signed by a person with capacity to understand and make decisions about his/her health care and treatment preferences. Common advance directives include:

 

The Health Care Proxy

 (HCP; sometimes referred to as “Power of Attorney for Health Care”) which authorizes another individual (“agent”) and if desired, an alternate – who must be at least 18 years old and of sound mind – to make decisions on the signer’s behalf if he/she loses capacity to do so. This power remains in effect only until the signer regains capacity; and may be activated multiple times during a person’s life. The “agent” need not be a relative or someone who lives nearby, nevertheless they need to be reachable.

A Living Will

A statement of an individual’s specific health care and treatment preferences. It does not name an “agent” to make these decisions on a person’s behalf. In New York State, a living will does not carry the same force as a health care proxy, but if a health care proxy has not been completed, medical staff may use a living will to guide their treatment decisions should the person be unable to articulate them. They also may consult family members or other individuals close to the person about any indication given about treatment preferences. 

The MOLST

(Medical Orders for Life-Sustaining Treatments; known, in some states, as a POLST — Physician Orders for Life-Sustaining Treatments), a newer form that allows an individual to specify treatment preferences about resuscitation, intubation, hospitalization, feeding tube, IV fluids, antibiotics, and comfort measures. However, unlike the health care proxy and living will, the MOLST/POLST is a medical order and, as such, must be signed by a physician, with two witnesses. Jewish Home Lifecare is working to have a MOLST completed and filed for every resident.”

  •  The Healthcare Proxy form can be downloaded on the New York State Department of Health website in English, Spanish, Chinese and Russian and does not need to be notarized.(http://www.health.state.ny.us/forms/#H) 
  • In addition to keeping a copies of the completed forms for oneself (in an accessible place), copies should be given to their physician and to the proxy(s).
  • While completing the forms is important, of even more importance are the conversations one has with his/her family and friends regarding their wishes.
  • All advance directives can be changed or revoked at any time as long as the individual is of sound mind. They should also be revisited periodically as technology changes as do circumstances. 
  • All directives are “portable” – as the patient transfers from home to hospital to assisted living, etc… the completed forms travel with them and do not need to be completed  again unless they have been revoked, in which case all extant copies should be destroyed.
  • Advance directives are not just for those who are near the end of their life. Anyone over the age of 18 who is of sound mind and has the ability to fill out the forms should do so.
  • Proper planning cannot be done soon enough and will eliminate the stress involved in snap decisions and will enable individuals to hold on to their freedom of choice.
  • There are lots of good resources out there to help individuals understand more about advance directives. In addition to looking at the New York State Department of Health website (http://www.health.state.ny.us/professionals/patients/patient_rights/)  Marcie suggests  reading “Difficult Decisions for Loving People” by Hank Dunn as well as visiting the website www.compassionandchoices.org

Educating residents and their families as well as colleagues about crucial palliative/end-of-life care decisions continues to be a huge initiative for Jewish Home Lifecare.

For more information and/or assistance please contact Marcie S. Gitlin, LMSW in the Bronx Social Work Department at 718-410-1252.