A question that comes up from time to time in my practice from clients is what exactly does Part 2 of the Advance Health Care Directive mean when they are referring to end-of-life decisions. The options are the Choice to Prolong Life and the Choice Not to Prolong Life.
The exact language that is housed in the Advance Health Care Directive is:
(2.1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below:
(a) Choice Not To Prolong Life
I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits, OR
(b) Choice To Prolong Life
I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.
The Advance Health Care Directive itself has some definitions and instructions. For example, it explains that Part 2 “…..of this form lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief. Space is also provided for you to add to the choices you have made or for you to write out any additional wishes. If you are satisfied to allow your agent to determine what is best for you in making end-of-life decisions, you need not fill out Part 2 of this form.”
For many, this explanation however doesn’t address when they would be considered to have an incurable and irreversible condition that would result in death within a relatively short time. Or explain when they would be considered to a reasonable degree of medical certainty to remain unconscious and not regain consciousness.
The reason that the state statute is written so broadly is that medical technology is constantly changing and it is unknown if a method of merely artificially preserving a body today will later be morphed into a treatment that can cure in the future.
In an attempt to spearhead the specificity problem, 14 states, including California, have adopted programs known as Physicians Orders for Life-Sustaining Treatment or Polst to better deal with this situation. Polst is meant to be a compliment to the Advance Health Care Directive. It is a document that must be signed by both a physician and the patient. It directly states whether or not a patient wants to be put on a breathing machine, feeding tube and/or to receive antibiotics.
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