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The Advance Health Care Directive, the Do-Not-Resuscitate Order, and the Physicians Order for Life Sustaining Treatment are the primary documents to be aware of. Let's examine them.
The Advance Health Care Directive ("AHCD") has two primary purposes: first, to express your health care wishes; and second, to authorize a health care agent to make medical decisions on your behalf only when you become incapacitated.
For example, whether or not to receive heroic life-sustaining treatment when in an irreversible vegetative state; whether or not to receive pain killing medicine if terminally ill even if it hastens an inevitable death; and whether or not to donate organs.
But the directive can also say who should be allowed to visit you while you are in hospital; what kind of human contact you want to be allowed; and how your funeral should be conducted. Your AHCD agent will have access to your confidential health care information and be authorized to make decisions on your behalf consistent with the wishes you express in you directive.
Various printed AHCD forms are available. The California Medical Association ("CMA") form is widely used and recognized by California hospitals. It can be ordered by phone at 800-882-1262 or online at http://www.cmanet.org. California also has its own version of the AHCD form.
A health care directive, however, cannot by itself prevent emergency responders from administering life support such as cardiopulmonary resuscitation (CPR). For persons who do not wish to have CPR and who wish to allow a natural death to occur, it is necessary to have either a "do not resuscitate" (DNR) form or a "physician's order for life sustaining treatment" ("POLST").
The Emergency Medical Services ("EMS") DNR form issued by the CMA is the older approach. A DNR form must be signed by the physician and the patient. A Medic-Alert bracelet should also be obtained and worn at all times so that emergency responders can immediately identify the person's DNR status. DNR forms require consultation with a physician and a physician's signature.
The more recent two page POLST form is much broader than the DNR form. Like the DNR form it requires a consultation with a physician. Unlike the DNR form, which serves only to say, "no CPR", the POLST form requires a broad discussion with the physician regarding the degree to which medical
treatment should be given on a wide range of issues: resuscitation, medical conditions, use of antibiotics, artificial nutrition, and other life sustaining treatments.
For example, the POLST form can be used to authorize that CPR be performed to restore one to a worthwhile condition of health, but otherwise to forego CPR.
POLST forms are signed by the physician and the patient, and are a doctor's order. The POLST form is
intended for a person who has a serious illness. It should accompany you wherever you go at all times. California's POLST is printed on bright pink stationary, but it can be printed on white paper too.
For more information regarding the POLST visit, www.capolst.org.
The POLST form, however, does not replace the AHCD. Only the AHCD allows you to authorize an agent to make health care decisions for you and to express your wishes regarding organ donation, funeral arrangements, and other concerns. Everyone should have an AHCD.
Dennis A. Fordham, attorney (LL.M. tax studies), is a State Bar Certified Specialist in Estate Planning, Probate and Trust Law. His office is at 55 First St., Lakeport, California. Dennis can be reached by e-mail at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at 707-263-3235. Visit his Web site at www.dennisfordhamlaw.com.
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