The Advance Directive is a legal document that is completed by the person who might need future medical treatment.  It has two primary objectives:  

• Allows you to name someone you trust to make health care decisions for you, in the event you cannot do so yourself.  This person can also be called Health Care Representative or a  surrogate decision maker.

• Empowers your health care representative to make decisions if you are close to death, permanently unconscious, have advanced progressive  illness or have extraordinary suffering.  You can specify whether you would like tube feeds or life support under these circumstances.

 
The Advance Directive is appropriate for any adult who wishes to share values, choices and instructions for future health care, often at a time when we have no idea what our future health status will be.  It gives you the opportunity to describe any things you would want or not want.  The more you share the less stress, confusion or potential conflict your loved ones are likely to face.   Even with really good communications, it is still very stressful, very burdensome to anyone who might have to make treatment decisions for you.
 
When making healthcare choices and giving directions to your healthcare representative,  it is helpful to think back on your personal and spiritual values, what it means to you to live well and what situations(s) would not be acceptable to you.


In choosing a health care representative, it is important that person is:

• Someone that you trust

• Someone who can make decisions in difficult moments

• Someone who would be capable of following your wishes, even if your wishes might conflict with other members of your family, and with what your health care representative would want for themselves in a similar situation.  When making decisions, the person you select would be substituting for you.

Remember to:

• Tell other family members who your representative is, so there are no surprises and so that they can be supportive of your decision maker.

• Select an alternate or two in case your chosen health care representative is unable to fulfill the role.

 
Emergency medical technicians (EMTs) cannot honor Advance Directives. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, whether  from accident sites,  home or long term care facility.  After a physician or nurse practitioner fully evaluates the person's condition,  advance directives can be implemented, and can be very, very helpful.

The POLST (Portable Orders for Life Sustaining Treatment) is a medical order.  The focus of the POLST is immediate, because the person involved has a known advanced illness or is becoming increasingly frail.  The form is signed by a physician (MD, DO, ND), a nurse practitioner, or a physician assistant after a conversation with the patient or the appropriate health care substitute decision maker.  It is a tool for translating patient’s preferences for the level of treatment he/she wants into medical orders that will be honored by emergency medical personnel (EMTs).
 
The form contains the following sections:

• Whether you want Emergency Medical personnel to attempt cardiopulmonary resuscitation  (CPR) if you do not have a pulse and/or are not breathing.

• Description of the level of treatment you prefer if you have a pulse and are breathing.

• The person who will sign the form lists those who were present for the discussion

• There is a place for the patient or the substitute decision maker to sign. Although recommended, this signature is not required. 

• Signature of the physician, nurse practitioner or physician's assistant.  By signing the form, that person attests that they know the orders on the POLST are what you want.

• There is also a place to opt out of submitting your  POLST orders to the Oregon POLST registry.  You can check the opt out box.

 
The Oregon POLST registry is an electronic registry that contains POLST forms filled out for Oregonians. It is available 24/7 so that emergency medical personnel can find out what medical orders are on your POLST.If there is a POLST document in the registry, the time for response is usually within 1 minute when emergency medical personnel contact the registry.EMS personnel then follow these medical orders.
 
Unless you opt out, the health care provider signing the POLST must submit your POLST to the registry.  The registry then sends you a packet.  This packed includes a letter confirming the medical orders that are on the POLST, and a magnet and stickers with your POLST ID number.  Most people put their POLST Registry Magnet on the refrigerator and stickers in their wallet, on their walker, or other visible places.  EMS personnel know that this is where they should look.


Your POLST should be reviewed when:

• You are transferred from one care setting to another (e.g. hospital tonursing home)

• when there is a change in your health status

• when your treatment wishes change

As one's illness / frailty progresses at the end of life, POLST orders are frequently revised to reflect the new reality.