Making Your Wishes Known: Advance Directives, POLST, and Other Difficult Things to Talk About

Posted By SHL Librarian

Presented by: The Rev. Susan Scott
Decedent Care Chaplain, Spiritual Care Service

Yusra Hussain, MD
Clinical Assistant Professor, Medicine
Stanford University Medical Center
September 25, 2013

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Advance care planning involves making decisions about the medical care you would want to receive if you become unable to speak for yourself. In other words, if you should stop breathing or your heart stops, what measures would you want taken? It’s essential to share and document your priorities: Without a plan, your health-care team won’t know what interventions to provide and your family may not know what to do.

There are several documents available to record your wishes. One of these is the advance directive, which provides information about your health-care wishes if you become unable to make decisions due to illness or incapacity.  Preparing a directive is not just for yourself but for your designated agent, the person who will help you if you are unable to let your feelings be known.

Guidelines for Care
The document allows you to think about and discuss your values: What’s important to you? What gives your life meaning? What does quality of life mean to you? What treatment options would you want?

“An advance directive allows others to know what is important to you and gives them the guidelines to make important decision based on your desires,” said The Rev. Susan Scott, decedent care chaplain of Stanford’s Spiritual Care Service, at a presentation sponsored by the Stanford Hospital Health Library. “The most important thing is to talk these things over first, so the person you want to make these decisions knows what to do and is willing to do it.”

Even if you don’t complete the full document, it’s important to have this type of conversation so your loved ones and/or agent have documentation should they need to make decisions on your behalf. The document should be placed with your medical records and be easily accessible in your home. Copies should be given to your agents—copies are considered as valid as the original. Many people carry a disc version in their wallet.

Someone to Speak for You
“An advance directive not only lets your wishes be clear, it also offers peace of mind to the people who want to be helpful during a crucial time,” she added. “Think about what others should know: The directive is a tool that is about you, your views, and your priorities.”

An advance directive allows you to designate a primary and secondary agent, and includes a section to list your preferences for end-of-life care and write about what’s important to you. There is also a section to indicate whether you would want to donate your organs.

Your agent needs to be over 18, and can be either a family member or friend.

Rev. Scott recommended that you choose your agent carefully and select someone with the right personality to stand their ground in the face of family opinions should they conflict with your wishes.

“It needs to be someone who knows you and who will honor your wishes, even if those wishes conflict with their own culture, spiritual, or personal beliefs,” she said. “They must be willing to take the privilege—and the responsibility— and be your advocate.”

Put it in Writing
Another important document is called Physician Orders for Life-Sustaining Treatment (POLST), which translates a patient’s goals for care at the end of life into medical orders that follow the patient across different medical settings. POLST is a legal document that allows physicians and other health care professionals to assess and convey the wishes of patients with serious illness or at an advanced age.

“This is a sensitive area that many people simply don’t want to talk about,” said Yusra Hussain, MD, a gerontologist at Stanford Hospital & Clinics. “But for people who are sick or ill, it’s very important for everyone to state their wishes in writing.”

Like an advance directive, a POLST is based on individual wishes and values, and what is an acceptable quality of life situation. POLST is a relatively new document that updates the traditional DNR (Do Not Resuscitate) form and provides additional instructions about what interventions you want, such as life-saving measures, intubation, and artificial nutrition. POLST involves a direct conversation with your physician and is entered into your electronic medical records.

Complementary Documents
POLST is not a replacement for an advance directive, Dr. Hussain said, but is more detailed and used during times of medical emergencies, such as severe illness or surgery. Unlike an advance directive, it is applicable in all settings: a hospital, a nursing home or at your own home, and can be easily replaced and updated. And while an advance directive is done by a patient, POLST is completed by the patient and the physician together and based on a shared conversation of goals of care. Many people keep a copy of their POLST on their refrigerator so that it can be easily found by emergency responders if there is a 911 call. .

“Think of an advance directive as a tool for your future and POLST for an immediate need,” said Dr. Hussain.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

Stanford Hospital & Clinics provides advance health care directives in several languages. You can obtain one by contacting the Spiritual Care Service at 650-723-5101 or Stanford Guest Services at 650-498-3333.

Stanford Aging Adult Services

Stanford Spiritual Care Service

California Health Care Directive

POLST California