The topic of palliative care is ethically complicated, especially with regards to situations where the patient’s condition is severe, and recovery is projected to be near impossible. In some cases, the person will be incapacitated as a result of the issue or some other cause and cannot make decisions. As such, medical workers have to make decisions such as the end of life-sustaining treatments based on some other authority. Advance health care directives and the more recent POLST forms serve to codify the transfer of decision-making power in the case that the patient cannot decide for himself or herself. This essay will discuss the principal characteristics of each variety of documents and highlight the differences between the two.
Advance Health Care Directives
The advance health care directive (AD) template for Florida can be found on the website of the CaringInfo national organization. CaringInfo (2005) formulates it in three parts: the designation of the health care surrogate, the living will, and the signature and witness provisions. As such, it assigns persons who may make medical decisions for me and instructs the physician on the action to take if any procedures would only prolong my death. According to Simmers, Simmers-Nartker, and Simmers-Kobelak (2017), the individual has to be competent at the time of signing, and two adults who do not benefit from his or her death have to witness the act. Competency involves a variety of factors such as mental health and age over 18.
It was not difficult to complete the AD based on the template, as it lets the person complete the form by filling in personal information and making several yes or no decisions which are explained in detail. However, it may be more challenging to create a valid AD that covers all of the necessary aspects without the template. Roscoe and Schenck (2017) state that in Florida, the document may be written without any specific format or pronounced orally as long as it is witnessed. Furthermore, Roscoe and Schenck (2017) discuss the cases of Terri Schiavo and another unnamed patient, which show how the document may generate issues by its absence or presence and disagreement with potential surrogates. As such, I am concerned that the AD I created may not be sufficient to cover every eventuality.
The use of POLST forms is a recent initiative that is designed to address some of the deficiencies that ADs tend to display. Capezuti, Malone, Gardner, Khan, and Baumann (2018) state that it is a medical order written by a physician for other care providers about the treatment of a patient with an irreversible condition under specific circumstances. The difference in authorship is intended to reduce the distance between the patient’s preferences and the measures taken by health care providers.
Like ADs, POLST forms do not require notarization to obtain legal power, but so far less than half of the states recognize them. Langton-Gilks (2018) claims that the practice is not acknowledged in Florida, though the University of Miami Health System and some other facilities are working on its development. A medical professional has to sign the form, with the list of those who can do so changing depending on the jurisdiction. The patient or their decision-maker may or may not have to sign, but it is strongly recommended to do so regardless to provide evidence of review and agreement.
The patient writes advance health care directives, and POLST forms are completed by a medical professional, usually a physician. The patient has to sign the AD alongside two witnesses personally, and POLST forms require the signature of a specific medical professional and sometimes that of the patient or their decision-maker. ADs are recognized throughout the United States, and POLST forms are only used in a small portion of the states that do not include Florida. However, some institutions in the state are working to adopt the program. Lastly, the two documents are not exclusive and complement each other, with POLST forms addressing the weaknesses and issues of ADs.
Both of these approaches are complicated by the fact that many people only begin considering these once they are convinced that their condition is terminal. In such situations, they may not retain decision-making capacity due to factors such as incapacitation. As such, the registered nurse should monitor their condition and try to make sure that they codify their wishes in one or both documents when they are capable of doing so. He or she should not attempt to interfere with the patient’s wishes and attempt to influence the decision. Patient advocacy and respect for autonomy demand that the nurse explains the options and lets the patient make the determinations.
Advance health care directives have existed for a considerable amount of time and helped patients with terminal conditions choose the treatment they would like. However, some issues also appeared throughout the years that showed their deficiencies and failures to address some concerns. POLST forms were created as a means to supplement some of these gaps, and the initiative is spreading throughout the United States. Florida has not adopted it yet, but it likely will do so soon, as the program is under development.
Capezuti, E. A., Malone, M. L., Gardner, D. S., Khan, A., & Baumann, S. L. (eds.). (2018). The encyclopedia of elder care: the comprehensive resource on geriatric health and social care (4th ed.). New York, NY: Springer.
CaringInfo. (2005). Florida advance directive. Web.
Langton-Gilks, S. (2018). Follow the child: Planning and having the best end-of-life care for your child. Philadelphia, PA: Jessica Kingsley Publisher.
Roscoe, L. A., & Schenck, D. P. (2017). Communication and bioethics at the end of life: Real cases, real dilemmas. Cham, Switzerland: Springer.
Simmers, L. M., Simmers-Nartker, K., & Simmers-Kobelak, S. (2017). Simmers DHO health science (8th ed.). Boston, MA: Cengage Learning.