Study Finds Need to Clarify Advance Health Care Directives

The purpose of an advance health care directive, whether in the form of a living will or health care power of attorney, is to express someone's preferences for future medical treatment. According to a new Journal of Emergency Medicine study led by a Pennsylvania physician, directives are often not clear enough about patients' wishes. The study also found that medical providers often misinterpret directives.

The study polled hundreds of physicians and found the majority of them had a poor understanding of living wills and do-not-resuscitate, or DNR, orders. The study emphasizes that it is critical to recognize the implications of living wills and health care powers of attorney and clarify them to ensure patient care and safety.

Advance Health Care Directives

A health care power of attorney is an estate planning document naming a health care agent to make treatment decisions. Examples of decisions included in a health care power of attorney include:

  • Authorizing, withholding or withdrawing medical care and surgical procedures
  • Authorizing, withholding or withdrawing food or water supplied by tube
  • Authorizing medical, nursing, or residential facility admission or discharge
  • Hiring or firing health care aides or medical staff
  • Requesting that a physician issue a DNR order and sign documents

A living will may be part of a health care power of attorney or may be a separate document. Through living wills, people make choices regarding life-sustaining treatment if they have an end-stage medical condition or are permanently unconscious. A living will may also be effective if the person has severe brain damage or brain disease, living will instructions should not come into play when a patient's illness is treatable, according to the study; if a patient has a heart attack, the physician should not look to the living will.

Pennsylvania Order for Life Sustaining Treatment

Patients in frail health can formalize their wishes regarding end-of-life medical care, especially in emergency situations, through Pennsylvania Orders for Life Sustaining Treatment, or POLST, forms. The University of Pittsburgh Medical Center's Aging Institute recommends that people with advanced illness or frailty use POLST forms in addition to advance directives.

According to the Institute, POLST forms are completely voluntary and should be completed only after a discussion of end-of-life choices with a legal decision-maker and physician. The physician will take the patient's goals and preferences for care and issue a POLST form.

The Pennsylvania Department of Aging has advised those creating advance health care directives and other end-of-life instructions to consult with their physician and estate planning attorney to ensure that their wishes comply with the law and are clearly expressed.