Monday, March 26, 2012

End-of-Life Wishes: A look at Advanced Directives


Firstly, the weaknesses of all advanced directives forms are that they are paper forms that can be lost, damaged, or difficult to locate when the time comes. While tattoos are not for everyone, the story of Joy Tomkin in England, who had her DNR end-of-life wishes tattooed over her heart is intriguing. It’s a successful move as far as making her wishes known. I don’t think her wishes could be any clearer really. (See links below for photos and story.)

While the main goal of any advanced directive is to make one's end-of-life wishes known, we spent some time reviewing and weighing some of the benefits and weaknesses of the three most popular forms: POLST, 5 Wishes and an Advanced Directives form.

POLST

Benefits
• Form used statewide means that medical/emergency responders will be familiar with it.
• The bright colors of the POLST forms should make them easy to locate.
• The hotline that Oregon’s POLST answers is a secondary backup to the forms, which also helps to ensure that final wishes are honored.
Weaknesses
• As the form itself states "No form can address all the medical treatment decisions that may need to be made."
• It is meant for those who are already ill or at an advanced age. (Healthier or younger individuals are not able to make use of the form.)
• A physician is required to sign the form to validate it. (This means the physician must agree and confirm the patient’s wishes, or the patient will not be allowed to even file the POLST form.)

Advanced Directive Form

Benefits
• This form breaks down different stages of the patient’s health/illness into 5 categories: "Close to death", "Permanently Unconscious", "Advanced Progressive Illness", "Extraordinary Suffering" and "General Instruction"
• The form is clear, easy to read and follow, and seems the best choice for the patient to clearly check off his/her wishes with additional lines to add a extra instructions/information.
• Any two witnesses can sign for the patient to confirm his/her wishes (except his/her present doctor.)
• The patient can appoint a health care representative to make decisions for him/her.
Weaknesses
• This form may not be as familiar or visible t emergency responders.
• The form is not as succinct and straightforward as the POLST form.

Five Wishes Form

Benefits
• This form covers more of the patient’s needs: "medical, personal, emotional, and spiritual".
• It promotes dialogue between the patient and his/her loved ones.
• The form has a wide variety of treatments that the patient can simply cross-out if she/he disagrees with it.
• The form is aesthetically pleasing and includes convenient wallet cards.
Weaknesses
• There is too much text and the form takes up 12 full pages.
• This form would be difficult for medical personnel to follow.
• Some states require notarization in addition to 2 witnesses, making the form invalid without it.

Forms Best for Each Individual/Entity
• Best for Medical Personnel = POLST
• Best for Patient to fill out on his/her own = Advanced Directive
• Best for Assisting a Patient to fill out = 5 Wishes

Advanced Directives Discussion
Join us on March 29th, when we guest host Death with Dignity's TweetChat for a discussion on Advanced Directives. We hope to see you there.

http://www.deathwithdignity.org/TweetChats/


References (Read More):
Joy Tomkins Story - http://www.dailymail.co.uk/news/article-2034647/Joy-Tomkins-81-resuscitate-tattoo-chest-PTO-inked-back.html
POLST Forms - http://www.ohsu.edu/polst/programs/sample-forms.htm
5 Wishes - http://www.agingwithdignity.org/five-wishes.php
Advanced Directives - http://liv-will1.uslivingwillregistry.com/forms.html

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