The Georgia Advance Directive for Health Care and the POLST (Physician’s Order for Life Sustaining Treatment) are both health care proxy forms. This blog will describe each document and its uses.
The Georgia Advance Directive for Health Care
The Georgia Advance Directive for Healthcare (viewable here) combines three different healthcare decision making documents that previously existed. The first of these documents is the Healthcare Power of Attorney, which is now embodied in Part One of the Advance Directive. In this Part of the Advance Directive, you (as the “Principal”) delegate health care decision-making authority to your decision-maker of choice (the “Agent”). The power that you delegate is quite broad: you are empowering your Agent to speak for you whenever you are unable to communicate your own healthcare preferences.
Part Two of the Advance Directive for Health Care fulfills the role that a stand-alone Living Will used to play. In Part Two of the Advance Directive, you state your preferences about what types of end-of-life care you would prefer to receive. Significantly, your Agents are not bound to the preferences that you state. Rather, your Agents are guided by your written preferences and by their knowledge of your values.
Part Three of the Advance Directive empowers you to list your preferred order of guardians, if you should ever need one. In order for someone else to become your Guardian, that person must submit a petition to the Probate Court in the county in which you reside that explains why you are incapable of making or communicating significant and responsible decisions about your health and safety.
Part Four of the Advance Directive is where you (as the Principal) sign the document in the presence of two witnesses, who also sign. Be careful not to have your Agents sign as witnesses, as this renders the document invalid. Significantly, a notary public is not required for the Advance Directive.
Here are the most significant points to remember about an Advance Directive:
- A patient must be a fully competent adult to complete an Advance Directive.
- You don’t need an attorney (or a physician) to complete an Advance Directive.
- The Agent only makes decisions if the Patient is not able to communicate about treatment wishes.
- Advance Directives only cover healthcare decisions and have nothing to do with your financial affairs.
- You can change your mind at any time, by completing a new form.
The Physician Order for Life Sustaining Treatment (POLST)
To read a current version of the Georgia POLST form, click here.
As noted on the back of the POLST, the POLST form is designed to be completed by individuals who have a serious illness or condition and are in their last year of life (in the judgment of a physician), or by individuals who have been “diagnosed with dementia or another degenerative disease or condition that attacks the brain and results in impaired thinking, memory, and behavior”. If an individual is unable to complete a POLST, then the form lists the order of individuals who are empowered to complete the document on his or her behalf, starting with that person’s Agent under an Advance Directive for Health Care, followed by a spouse, then a Court-appointed guardian, then an adult son or daughter, then a parent, and then an adult sibling. Any individual completing the form must choose treatment options “in good faith based upon what the patient would have wanted if the patient understood his or her current treatment options.”
Because a POLST is a physician’s order, it is enforceable as such. A healthcare provider who has knowledge of a POLST is bound to follow it. In contrast, the Advance Directive only provides a statement of a patient’s wishes and the agent ultimately chooses the treatments.
The POLST form begins with consideration of a patient’s wishes if he or she were to have no pulse and/or could not breathe. Here, a Patient will communicate with the physician completing the form whether the patient would want CPR or not. The patient is then asked to indicate what level of medical intervention the patient would want- i.e., whether the patient would merely want comfort measures, or limited interventions, or full treatment. The POLST also asks about the patient’s wishes regarding the use of antibiotics. Finally, the POLST queries about the patient’s wishes regarding artificially administered nutrition and fluids.
Significantly, if the POLST is completed by the Patient and a Physician, there are no restrictions on how the orders in the POLST may be implemented. In contrast, if the POLST is completed by the patient’s Health Care Agent (Under a Georgia Advance Directive for Health Care), a DNR (Do Not Resuscitate) order can only be implemented when a Patient is a “candidate for non-resuscitation” as defined by OCGA 31-39-2(4).
The POLST form requires the signature of the Patient or Authorized Person, and the physician who complete it. Significantly, if an Authorized Person is signing the form because a patient cannot do so, and if the Authorized Person chooses not to have the patient receive CPR (instead choosing the option “Allow Natural Death to Occur”, the POLST must also be signed by a second (concurring) physician.
Last but not least, the POLST form provides that when a patient is transferred from one care setting to another, released to return home, if there a substantial change in the patient’s status, or if the patient’s treatment preferences change, then a physician should review the form, and sign it while noting the location, date, and time of their review, and to indicate whether their review resulted in the POLST form remaining intact with no changes, whether it was voided and a new form completed, or whether it was voided and no new form was completed.
Every adult in Georgia should have an Advance Directive in place so that their basic wishes about their end-of-life care options are known and so that there is a clearly codified order of people to make these decisions if the adult cannot do so. The POLST is typically limited to patients in their last year of life or those with degenerative diseases that attack the brain. However, the POLST is such a powerful and specific document that some believe that its use should not necessarily be so limited. Should a healthy person ask her physician to complete a POLST? Arguably, this is not a bad idea, as the POLST will ask many questions that an Advance Directive does not. However, it may be several years before healthcare providers and their staff are comfortable with all of the nuances of the POLST as compared to the Health Care Directive. In the end, as with so many decisions about your care, you might have to ask your doctor if a POLST is right for you.