What Documents Are Used for End of Life Planning? - Spokane, North Idaho News & Weather KHQ.com

What Documents Are Used for End of Life Planning?

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(provided by Dick & Karen Sayre, Sayre & Sayre, p.s.)

There are a number of documents which can help make certain that your wishes are followed. Living Wills and which are now called Washington State Health Care Directives and Durable Powers of Attorney are among the most important.

In 1979, the Washington legislature enacted the Natural Death Act, which allows individuals to sign a written directive to physicians, hospitals and other health care providers to withhold or withdraw life sustaining procedures if the individual has been diagnosed by two physicians as having a terminal condition and death is determined to be imminent.  The legislature changed the Natural Death Act effective June of 1992, and completely revised the scheme to permit Washington residents to refuse nutrition and hydration if the ill person is in a coma or a "chronic vegetative state".  Such a directive is valid and will be followed, but only if executed in the statutory form.  Directives which predate June of 1992 are "grandfathered" into the new law; however, most of them do not address the nutrition and hydration issues, and will only be valid if they substantially comply with the 1992 legislation.  Unfortunately, many of the so-called "Living Wills" executed by Washington residents are not in the statutory form, and were not  grandfathered in by the 1992 law, because they were not in compliance with the prior law.  To be completely sure of validity, all such directives and so called Living Wills should be reviewed by a Washington attorney familiar with the change in legislation.  Attorneys who practice "Elder Law" are usually the best resource for this review.

Note also that medical care is distinct from the administration of life sustaining food and water, which is not considered "medical".  If a person wishes to direct the cessation or withdrawal of basic necessities (such as food and hydration), they must specifically include such power in their directive and "Living Will", or Durable Power of Attorney, if they elect to use that format in combination with the directive.  In either instance, consideration should be given to utilizing a Durable Power of Attorney with health care decision making powers, which is the document naming a surrogate decision maker. 

A Washington directive is effective to remove life support only if your physician or two physicians familiar with your case determine that your death is imminent, regardless of whether life sustaining procedures are utilized.  The approval of two physicians is  required for the removal of nutrition and hydration under the 1992 law.  If medical procedures might significantly prolong life, the directive is not binding on the health care provider.  For this reason, use of a Durable Power of Attorney with health care decision-making powers also is advised.

Do Not Resuscitate forms or DNRs were bright in color and used to be available at fire stations.  This was a form which stated that, if your heart stops and you have stopped breathing, you do not wish to have emergency medical technicians or other health care professionals take any action to restart your heart or breathing.  The document was used only in a situation in which you have no pulse and are not breathing.  It does not address any other medical emergency or any other actions which might be taken by emergency personnel or other health care professionals. 

If you are not currently ill and have not experienced any medical problems, you may not wish to have such a document in effect. A DNR or similar document is intended for use by individuals at the end of life, who wish to be allowed to die naturally from their current illness or condition.  If you are otherwise healthy, it is quite possible you could be quickly resuscitated and do well with proper treatment, so this form is not for you.  

Today, if you have a chronic or prolonged disease you should consider meeting with your physician and jointly executing a Physician's Order on Life Sustaining Treatment (POLST).  They are valid only after they have been signed by both patient and physician.  These forms are used for the purpose of setting down in writing a patient's desires during the course of their illness.  They are physician's orders, and  were designed to be filled out and signed in conjunction with a consultation between doctor and patient. The form describes what measures the patient wants their doctor and other health care professionals to take in the case of certain occurrences in the course of an illness.  The document, when signed by yourself and your doctor, become doctor's orders and are to be followed by medical personnel even before your doctor is contacted.  They are bright green in color, and have replaced the old DRN form.

The document is divided into five sections, each of which deal with a separate type of action.  These sections include; whether you would chose to receive cardiopulmonary resuscitation; specific medical interventions; comfort measures only, the use of oxygen, manual treatment of airway obstruction, wound care and other measures to relieve pain and suffering; the use of antibiotics;  the use of artificially administered nutrition, such as tube feeding; and a summary of the goals set by you as a patient.

As with a DNR, a POLST is not really appropriate for otherwise healthy individuals.  It is intended to deal with end of life issues for people whose life is affected by disease or other life threatening disability.  Unlike a DNR, it provides a set of options for emergency personnel relative to different situations, which allows for better treatment overall.

Neither the POLST or DNR replace the Health Care Directive.  The DNR and POLST deal with the administration of life saving treatment normally administered by emergency personnel.  The Directive is used to continue or remove life sustaining treatment following emergency treatment, and is most commonly used in a hospital setting to allow a person in a coma or permanent unconscious condition to die naturally, if that is their wish.

You can learn more about Durable Powers of Attorney by reviewing the section discussing how to obtain authority to help manage a spouse or parents' affairs.

(Sayre and Sayre is a Spokane-based law firm specializing in Elder Law issues)
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