Advance Directives

What Are They and Why Are They Important?

Denise J. Brandon, PhD

Types of Advance Directives

• Appointment of Health Care Agent

(Formerly Durable Power of Attorney for Health Care)

• Advance Care Plan (Formerly Living Will)

What is a Health Care Agent?

Definition:A health care agent is an adult or emancipated minor who is appointed by another person to make health care decisions for the person.

Appointing a Health Care Agent

Any competent adult or emancipated minor can

appoint a health care agent by following these

steps:• Complete a form which complies with the law

(see sample form at http://health.state.tn.us/AdvanceDirectives/)

• Have it witnessed by 2 adults, or• Have it notarized by a notary public

When Does the Health Care Agent Take Over?

Unless your advance directive specifies otherwise, your health care agent will only have authority to make health care decisions for you if you cannot make your own decisions.

Once you can make decisions again, your health care agent will no longer make medical decisions for you.

How to Change or Revoke your Health Care Agent

• Provide a signed written statement informing your supervising health care provider that you are revoking your current Health Care Agent.

• Legally ending your marriage revokes designation of your spouse as the Health Care Agent unless you specify otherwise.

• Designating a new Health Care Agent revokes the earlier designation.

What is an Advance Care Plan?

Definition:An Advance Care Plan (formerly called a Living Will) is an individual instruction or a written statement that gives the person’s directions for withholding or withdrawing life-prolonging interventions. It must be done voluntarily and witnessed.

Developing an Advance Care Plan

Any competent adult or emancipated minor can

develop an Advance Care Plan by following

these steps:• Complete a form that complies with the law

(see sample form at http://health.state.tn.us/AdvanceDirectives)

• Have the form witnessed by 2 adults, or • Have it notarized by a notary public

Choosing your witnesses

The following persons cannot serve as

witnesses: The person being appointed as your health care

agent. Your surrogate health care agent The person financially responsible for your medical

care. Your attending physician At least one witness must not be related by blood/

marriage or adoption or entitled to any portion of your estate

How Can I change my Advance Care Plan?

• If you are mentally capable, you may revoke all or part of the Advance Care Plan at any time in any way that communicates an intent to revoke

• A new Advance Care Plan revokes an earlier Advance Care Plan or Living Will.

Should I change my existing Living Will or Durable Power of Attorney for Health Care ?

• New law took effect July 1, 2004

• New forms are easier to understand

• New language is used

• Living Wills and Durable Power of Attorney for Health Care will be honored.

What should be done with an Advance Directive after signing?

Give copies to:• Health Care Agent• Successor Agent• Your Doctor• Your local Hospital

Put original in a safe place and notify your agent of its location.

How are Advance Directives Implemented?

• Physician Orders for Scope of Treatment (POST) universal form was created to do the following:– Address DNR and other resuscitative

services – Be utilized by all healthcare entities in the

state i.e. EMS, Nursing Homes, Hospitals, etc.

– Go with the patient and be recognized across state lines

What is POST?

• POST – Physician Orders for Scope of Treatment

– Standardized form containing physician’s orders regarding the patient’s preferences for end of life care

– Complements, but does not replace Appointment of Health Care Agent &/or Living Will/Advance Care Plan

When is POST effective?

• Effective immediately upon order written and when all requirements met

• Requirements for valid POST:– Patient’s name and signature (Patient signature

optional according to facility policy)– Orders– Physician’s signature (MD/DO)– Basis for orders

Who needs a POST form?

• Post is for

– Seriously ill patients with chronic progressive illnesses

– Terminally ill patients

What information does POST include?

• Patient’s Name and date of birth

• Whether or not to resuscitate

• Level of intervention

• Whether or not to hospitalize

• Use or withholding of antibiotics and feeding tubes

Who Can Fill Out POST Form?

• Physician

• Social Worker – experienced in a health care setting

• Nurse

If patient has a DNR Order, is a POST needed?

Yes, because POST addresses more thanjust DNR – It addresses…

– Comfort level– IVs/Nutrition– Antibiotics– Documents who was involved in discussion of orders– Includes signature of patient, parent/guardian or Health Care Agent

Do I need POST if I already have an Advance Directive?

• POST reinforces wishes expressed in an advance directive

• POST is a physician’s order that will be used to direct the care of the patient

• Recommend very ill patients have both, POST & Advance Directive

POST helps with implementation of Advance Directives

• By law it MUST accompany the patient

• It contains specific information on care

• It IS a physician’s order – no interpretation is needed and POST orders are to be followed

Take-Home Messages (about POST Form)

• POST provides a better means to identify and respect patient’s wishes

• POST will improve end-of-life care throughout the system

• The POST Form can be found at the following websites: – www.tennessee.gov/health – www.endoflifecaretn.org

In Summary:

• Everyone needs an Advance Care Plan and a Health Care Agent to make sure that their wishes are carried out should they be in a situation where they cannot tell their treatment providers what they desire.

• POST forms help assure that Advance Directives are carried out.

• For more information, visit the state website at http://health.state.tn.us/AdvanceDirectives/