Advance care planning in the United States

According to the article, the process for setting out advance care directives in the United States is as follows: 

1. People specify in their living will the care that they would want towards the end of their life
2. They nominate a decision-maker to take over their medical decision-making should they become incapacitated 
3. Their doctor signs a document known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that their wishes are followed and that the orders are clear enough to ensure that the patient will receive the treatment they would want
4. These orders become the basis for conversations with the family of the patient to determine what form of care is appropriate towards the end of the patient’s lief
5. The doctor and either the patient or their nominated decision-maker will then sign a single page document specifying the patient’s choice of care 
6. These forms are “conspicuously highlighted” in the patient’s medical record so that any health care professional caring for the patient will be aware of the patients preferences for health care interventions at the end of their life 

According to the article, fifteen states have already enacted laws or regulations to authorize use of these forms. Similar efforts are under development in another 28 states. The laws generally allow medical institutions to decide whether to offer the forms and always allow patients and families to decide voluntarily whether to use them. 

The article states that advance planning for end of life decisions is increasing despite the deletion of references to end of life planning from the health care reform bill which made voluntary provision for doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. 

The conclusions drawn are that end of life conversations and medical orders detailing what care to provide increase the confidence of patients that they will get the care they really want.  As a secondary benefit, it is suggested that specifying patient choices may also help reduce the cost of health care at the end of life. 

Read the full article on the New York Times online.