By Caron Woodward
While facing one’s own mortality can be uncomfortable for some, planning for end-of-life care is best approached pragmatically. There are many options for planning that ensure one can cover any necessities as they become appropriate, including decisions about life-sustaining treatment, agents to assist in healthcare decisions, and other personal directives. There are many documents routinely used for these purposes, and it may be overwhelming to know what is necessary for each individual.
Preferred Intensity of Treatment Form (PIT)
These forms are common in skilled nursing facilities to direct medical professionals in a specific facility on the care preferences of a patient. Particularly helpful in long-term care situations where medical professionals may rotate, a PIT can ensure that there is consistency on a patient’s treatment. These forms are signed by a doctor and are also sometimes referred to as a Preferred Intensity of Care (PIC) form.
Advance Health Care Directive Form
This is a statutory form developed in California to cover basic end-of-life decisions. Many people think this form assigns the decision-making to another person. However, the form allows an individual to outline the type of care that they desire and appoint an agent to make sure these decisions are carried out in the event that the planner becomes incapacitated or cannot express their wishes to medical professionals and others. In the Advance Health Care Directive, an individual elects an agent, decides when the agent’s authority becomes effective (immediately, upon declaration of two licensed physicians, etc.), and provides instructions on decisions to prolong or not to prolong life, relief from pain, and organ donation. This document also provides for an appointment of a conservator, should one become necessary.
HIPAA Authorization
HIPAA is the Health Insurance Portability and Accountability Act of 1996 and provides for data privacy and security provisions for safeguarding medical information. In short, this keeps medical professionals from discussing an individual’s medical history or current medical status to anyone who does not have authority. This document allows healthcare providers to share this protected information with a person’s designated agents or agents, so they may assist in making health care decisions. This is an invaluable tool. As an example, Mom is in an auto accident and temporarily unconscious, and her daughter who was driving the car and is present in the hospital wants to direct the doctors according to her mom’s wishes. Daughter does not know that the treatment she believes to best would have an adverse reaction with one of Mom’s current medications, and the doctor cannot tell her due to HIPAA privacy laws. Daughter may become frustrated that the doctor will not consider her direction, and Doctor will become frustrated that she cannot discuss other options with Daughter. Meanwhile, Mom is not receiving the comprehensive care that she could if Doctor had the ability to share her medical information with Daughter.
Do Not Resuscitate Form
Commonly referred to as a “DNR” this type of directive was enacted in 1994 to protect medical professionals who honored patients’ direction to withhold certain life-sustaining treatments. The form directs health care professionals to forego efforts to resuscitate an individual who is in cardiopulmonary arrest or is not breathing. A patient must sign this form, or it must be signed by an individual with authority to sign, such as a conservator, designated health care agent, or spouse who believe that a DNR is consistent with the patient’s wishes. A doctor must also sign the form, indicating that the patient (or the patient’s representative) is making an informed decision.
Physician Orders for Life-Sustaining Treatment (POLST)
A POLST is designed for use by an individual who is in a very frail condition or near the end of life. This document has 4 sections. The first directs medical professionals regarding the administration of CPR if the patient is unconscious, has no pulse and is not breathing, and is somewhat similar to a DNR. The next applies when a patient has a pulse and is breathing, and directs emergency personnel or the type of treatment desired by the patient. Section C deals with preferences regarding artificially administered nutrition. The last section is for signatures. Since this is a medical order, it must be signed by a physician, nurse practitioner, or physician assistant acting under a physician’s supervision. It also must be signed by the patient or an authorized signatory of the patient who will make decisions according to the patient’s wishes and values.
A combination of these documents is recommended to safeguard that a comprehensive plan is in place when one becomes incapacitated or near the end of life. It is important to have discussions with medical and legal professionals to ensure a complete understanding of the options available for this type of planning. Establishing a strategy for end-of-life care can provide peace of mind to the planner and can be one of the most thoughtful gifts one can provide loved ones.
For more information about end of life planning or estate planning, please contact us.
Caron Woodward is an attorney with Clear Sky Law Group. She reached at (858) 598-5552 or cwoodward@clearskylaw.com