Part of our basic estate plan is helping our clients draft Advance Health Care Directives. The Advance Health Care Directive identifies the individuals that you desire to act for you if you become unable to make medical decisions for yourself.
The most common decision involves when, and under what circumstances, extraordinary measures should be used to prolong life. There are also sections of the Advanced Health Care Directive which deal with whether or not you desire to be an organ donor. This is part of our basic estate plan package.
On July 2, 1010, the Los Angeles Times had an article entitled "California program helps people record wishes at end of life." This article is about a program used in California to help nursing home and terminally ill patients express their wishes regarding treatment at the end of life.
Efforts to increase awareness about the program are being led in California by the Coalition for Compassionate Care of California and the California HealthCare Foundation. Information and opportunities to learn about the program can also be found on this web site.
The program is called Physician Orders for Life-Sustaining Treatment (POLST) and has been adopted in many nursing homes, hospitals and long-term care facilities in California beginning in January, 2009. The program involves an innovative medical form, that is signed by a doctor, allowing patients to specify what kind of care they want at the end of life, such as feeding tubes and other medical interventions. The form was designed 20 years ago in Oregon because of concerns that traditional Do Not Resuscitate orders and advanced directives do not fully communicate patients' wishes for many situations and types of treatments.
POLST forms are different that advanced health care directives. However, advanced health care directives can help your family members complete the POLST forms in the event that you are incapacitated and are evidence of your intentions. Here are sample POLST forms in a variety of languages.
POLST forms address when and if there should be (1) cardiopulmonary resuscitation when the person has no pulse is not breathing or if there should be a DNR [do not resuscitate]; (2) medical interventions when the person has pulse and/or is breathing ranging from only comfort, limited interventions (such as IV or antibiotics) or full treatment (intubation, defribillation, intensive care); and (3) artificially administered nutrition. This form can be modified at any time as long as there is capacity. When there is not capacity, the advance health care directive can demonstrate intent. POLST forms are signed by the physician at the hospital.
In order to prepare for determining your intentions, I would suggest that you read an Advanced Health Care Directive or read the information available on these websites, and think about the following questions:
(1) Who do you want to make health care decisions for you when you can't make them?
(2) What kind of medical treatment do you want or don't want?
(3) How comfortable you want to be?
(4) How do you want people to treat you?
(5) What would you want your loved ones to know about your health condition?
It is an excellent idea for those executing Advance Health Care Directives to speak openly and honestly with the person or persons they designate and go through the different situations that might come up. While no one can anticipate every medical situation, a thoughtful and reasoned discussion can cover the more likely scenarios.
Posted by Henry (Hank) J. Moravec, III, a partner at Moravec, Varga and Mooney. For a complimentary 30 minute consultation (telephonic or in person), you can e-mail Hank Moravec at firstname.lastname@example.org or call him at (626) 793-3210.
He focuses his practice on Estate Planning, Trust and Probate Administration, Beneficiary and Trustee Representation, Probate Litigation, Tax Law, and Nonprofit Law. He represents clients throughout Southern California and his offices are conveniently located for clients in the Los Angeles, Orange, Santa Barbara, Riverside and San Bernardino Counties.