The Advance Directive (AD)
An advance directive is a legitimate manuscript used to highlight particular prospect clinical care resolutions only when one is not healthy physically or mentally to make his or her medical care decisions. The form authorizes a health care representative or an attorney to complete treatment and other medical selections for a person in his or her critical health state (Butts & Rich, 2019). The AD is strictly employed at a crucial time when an individual is incurably sick or is permanently unconscious. According to Butts and Rich (2019), the living will state the kinds of medicinal management the person would like or not like to obtain in these circumstances. The document defines under which situations an effort to prolong life should be executed or denied. The above-stated might include; dialysis, tube feedings, and life support equipment, among other services.
Before creating an advance directive, one should discuss it with their health care practitioner, loved ones, and at least one individual who would be chosen as the substitute decision-maker. Heyland (2020) explains that the will-maker should talk about his or her health status, desires, and fears that will guide the decision-making process. When picking the health representatives, the patient should choose someone who knows them well, and one trusted to implement his or her medical desires. Before some health care personnel utilizes AD to lead clinical choices, at least two doctors must ascertain one is incapable of making his or her treatment choices (Heyland, 2020). Additionally, a person’s illness must meet the state law specifications for incurable disease or permanent unconsciousness.
The State of Indiana AD
I filled the State of Indiana advanced directive that I obtained from the CaringInfo, a program of the National Hospice and Palliative Care Organization (NHPCO). The State of Indiana law has various requirements for the completion of the AD form. First, the person filling the form must communicate with his or her relatives, acquaintances, and doctors about their advance directives and ensure that the agent one appoints understands the person’s wishes. Second, once the document is completed and signed, the person should produce several copies for; healthcare representative, family, friends, clinicians, or religious mentors who can provide the form in case of an emergency (Patients and caregivers, 2021). Third, the state policies also allow one to save a duplicate of the AD in a virtual private medical documents application. Thus, this permits sharing of health reports with doctors, relatives, and other parties who may be involved in end-of-life care.
The Indiana state AD completing procedure follows three main steps. The first step is the selection of the healthcare representative and the power of attorney. In this stage, the client appoints trusted people to execute his or her wishes during a health crisis. The second phase involved writing down all the desires to be done or not to be done during the illness and also in the case of death. The last stage of formulating the AD in Indiana involves all the parties signing the document in front of witnesses. When this process is followed by all individuals over 18 years, the record is considered a legal advance directive for the state of Indiana’s health policies (Heyland, 2020). The above procedure will have followed the Indiana 30-5-5-16 and 30-5-5-17 codes of healthcare.
The Filling of AD
While filling the AD form, I was in a dilemma; I felt like I will have power even when in critical conditions by having someone follow my wishes. At the same time, I felt hopeless that my life would be in someone’s hand. Second, I felt as if I was already in the future; pictures of me lying on the bed helpless crossed my mind. The above feeling almost made me stop filling the form, but I remembered my end life care was more important than what I felt at that moment. While writing down my wishes, I thought that experiencing that situation will may make me feel different. I would want to change my wishes at that moment of time. There will be no opportunity to change anything when it happens, however, my healthcare representative will execute my desire according to what I planned earlier.
My feelings were in line with studies published about the confusion and challenges individuals face during this process. Pozgar (2019) documented the above dilemmas and argued that individuals must have thought carefully about the living will before getting one. Talking to family, friends, physicians, and even going for therapy will help reduce negative emotions during the process. Pozgar (2019) adds that contracting a person one trusts will give the patient the confidence that they will be in good care. The Indiana state laws on advance directives agree with the sentiments of Pozgar. Also, I felt the importance of the AD; by having this law, the state allows me to make my own health decisions when I am not able physically. The AD saves families and friends the challenges of deciding what best for patients.
Physician Orders for Life-Sustaining Treatment (POLST) Form
POLST is an end-of-life strategy documentation filled with when the doctors have ascertained the patient has a life-threatening condition and a maximum of one year to live. A POLST form encloses a patient’s directives for clinical therapy for particular medical emergencies or complications. The record indicates whether or in what circumstances one would like to receive cardiopulmonary resuscitation (CPR), be admitted to a hospital, and obtain medically-aided feeding, among other kinds of critical care (Lovadini et al., 2019). The form might also indicate whether an individual intends to donate organs when he or she dies. A POLST is made to be utilized when one is seriously sick and at risk of suffering a life-threatening incident. According to Hayes et al. (2017), a POLST form must be filled by a physician regarding a discussion with a patient about his or her priorities. A Physician Orders for Life-Sustaining Treatment can only be recognized as a legal document signed by a doctor, a registered nurse, or a doctor’s associate, which depends on different jurisdictions.
The AD and the POLST
The advance directive and the POLST are critical legal documents that guide the acquisition of health interventions at the end of life. The two forms give patients the autonomy to make health decisions even if they are not physically or consciously able to do so. The duo makes the process of making health decisions for loved ones easier for families and doctors. In the two cases, patients make their medical wishes known to all parties that might be involved in their end-of-life care so that no one can take advantage of the sick. The main objective of the AD and POLST is to ensure that patients make their health decisions even physically and emotionally cannot. The two vary in implementation and execution from one state to another because medical policies also differ from one region to another.
Though the two medical legalities complement one another, they have differences. First, the advance directive identifies a health representative who makes the decisions on behalf of a patient and gives recommendations for a patient’s wishes; the POLSTs guarantee those wishes are executed medically. Second, POLST is envisioned to be utilized only if a person is severely sick and at risk of undergoing a life-threatening circumstance. On the other hand, an advance directive can and should be filled at any time, independent of one’s present health status. Third, emergency medical service (EMS) staff can follow POLST to treat an individual while the EMS cannot follow a patient’s advance directive during an emergency (Butts & Rich, 2019). Also, a POLST form is a medical order, and a copy is kept in one’s medical record, so it is easily accessed in case of an emergency while an AD is harder to find. Everyone should complete a POLST due to its necessity in emergency cases, while AD is not a must for everybody.
Making a health care choice requires a patient to have quality information to make informed decisions. For instance, a patient might want a particular service, but the question is, does the patient understand what that service entails? It is the role of registered nurses to provide these patients with current information on all care amenities they need. Ensuring the earlier mentioned guarantees patient’s autonomy in a more significant way. The RNs should have skills and knowledge to guide the clients through advanced health care directives while observing operational ethics. Additionally, the RNs also provide customers with the pros and cons of each care so that the patient weighs their options before deciding.
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
Hayes, S. A., Zive, D., Ferrell, B., & Tolle, S. W. (2017). The role of advanced practice registered nurses in the completion of physician orders for life-sustaining treatment. Journal of Palliative Medicine, 20(4), 415-419.
Heyland, D. (2020). Advance care planning (ACP) vs. Advance serious illness preparations and planning (ASIPP). Healthcare, 8(3), 218.
Lovadini, G. B., Fukushima, F. B., Schoueri, J. F. L., Dos Reis, R., Fonseca, C. G. F., Rodriguez, J. J. C., & de Oliveira Vidal, E. I. (2019). Evaluation of the interrater reliability of end-of-life medical orders in the physician orders for life-sustaining treatment form. JAMA Network Open, 2(4).
Patients and caregivers (2021). National Hospice and Palliative Care Organization (NHPCO).
Pozgar, G. D. (2019). Legal and ethical issues for health professionals. Jones & Bartlett Learning.