COVID-19: Advanced Directives

COVID-19: Advanced Directives

The discussion of whether you should create your advanced directives has been a topic that may not be at the forefront of your mind. However, with the current public health pandemic of COVID-19, it is something everyone should consider keeping in their medical toolkit. While this topic is emotionally difficult, life is unpredictable and there are circumstances such as an automobile accident, stroke, or sudden serious illness that leaves you with the inability to communicate.

WHAT IS AN ADVANCED DIRECTIVE?
An advanced health care directive is a document that puts together, in writing, a person’s wishes when they are no longer able to speak for themselves. Your voice matters and to ensure your wishes are known, it is important to document them in advance. If you don’t prepare an advanced directive, no one will know your wishes to advocate for you. This document helps the medical team know how to care for you if you are suddenly in a medical crisis. It is not for the sole purpose of a terminal illness, such as end-stage cancer (discussed below), rather it is a document that allows you to state your wishes for your future health care in the event of any situation in which you can no longer speak for yourself. It relieves the burden from your family or those close to you if your wishes are known in advance.

ADVANCED DIRECTIVES TYPICALLY HAVE TWO PARTS:

  1. A living will: This informs family, friends, and the medical team your wishes for end-of-life care if you were seriously ill and unable to make your decisions. These can include decisions about CPR, life support (feeding tubes, ventilators), and dialysis. It can include full or limited treatment and comfort care such as palliative or hospice care.
  2. A durable power of attorney or healthcare proxy: This allows you to appoint a person you trust as your healthcare agent or decision-maker. This person makes the treatment decisions on your behalf if you are unable to make them yourself. 

Both of these documents vary by state, and you do not need a lawyer to complete the advanced directive. Depending on your state’s requirements (signed and witnessed or notarized), your documents are legally binding. You can search your state’s requirements through your State Health and Human Services Department.

PHYSICIAN ORDER FOR LIFE-SUSTAINING TREATMENTS:
The final document I want to mention is a Physician Orders for Life-Sustaining Treatment (POLST). The name varies by state (MOLST, MOST, POST or TROPP). POLST forms are signed orders by a physician for specific medical treatments you want during a medical emergency. The emergency medical services’ (EMS) standard of care is to do everything possible to attempt to save a life. This form indicates which treatments you do not want, such as “Do Not Resuscitate.” These are appropriate for individuals with end-of-life diseases or advanced illnesses. These documents require a signature by a health care provider that is designated by the statue to be effective. This is a doctor’s order and does not replace an advanced directive, rather it is used in combination. Not everyone needs a POLST form, so only consider if you are diagnosed with a serious illness. National POLST explains in detail about POLST forms.

Here are some references to start your conversation about advanced care directives: