Advance Care Planning: Beyond The Documents

Advance directives and POST documents

Well-informed Medical Decisions

Well-informed Medical Decisions

Making medical decisions for someone else during a time of crisis can be a prescription for error. Talking about end-of-life issues is difficult, but documenting a patient’s wishes prior to a medical event removes a lot of emotional burdens from family members.

I remember a patient who had end-stage COPD and was in the emergency room in respiratory distress. She had an advance directive instructing no intubation, yet her distressed family requested the procedure.

Medical personnel gathered the family and explained the patient’s wishes and how she had relieved them from the burden of that decision by signing an advance directive document. Intubating would have denied the patient’s wishes, so the family agreed to abide by them.

A 68-year-old in a nursing home had completed a POST (Physician Orders for Scope of Treatment) document indicating he didn’t ever want a feeding tube, given his advanced Alzheimer’s Disease. It also indicated that he didn’t want to be intubated, but did want CPR. Unfortunately, his document was not signed by a doctor, so when he experienced respiratory arrest in the emergency room, he was intubated.

Without the physician’s signature on his POST document, it was deemed invalid and because no family members were present, his wishes were not honored. Ensuring that advance directive are signed and in your medical record are important steps to getting care that honors your wishes.

Appropriate documents are only part of advance care planning. You and your loved ones should understand your medical choices.

Making informed end-of-life medical decisions include:

  • Fully understanding your medical condition, potential complications and potential gaps.
  • Prior experiences with family or friends with serious illnesses.
  • Understanding life-sustaining treatments during medical emergencies, including the benefits and risks with CPR, mechanical ventilation or tube feeding.
  • Goals for treatment (comfort care, trial treatments, full intervention) or any associated fears and worries.
  • Documents that provide specific instructions for end-of-life care, such as a living will, do-not-resuscitate order or a physician orders for scope of treatment (POST) form.