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I obtained the advance directive (AD) for the state of Florida by printing it from the official website of the National Hospice and Palliative Care Organization (2017) and its program for end of life care, CaringInfo. ADs give people an opportunity to have some level of autonomy over their health even when they cannot make decisions for themselves. An AD in Florida has three parts, two of which can be completed by ones choice. It is a legal document, and while it is not a will, the state recognizes its authority in a similar way (Luck et al., 2017). It is important to mention that this document is only valid in the state in which its maker lives.
The law of the state requires the will to be signed not only by its creator but also by two witnesses, and one of them cannot be the makers relative or spouse. These witnesses cannot be this persons designated surrogates as well. Also, according to the NHPCO (2017), a spouse can lose his or her rights to be a surrogate in case of divorce. The maker should state whether he or she wants to ignore this rule while creating the AD.
The Florida Legislature gives individuals a possibility of designating people to act on their behalf and stating their wishes for end of life care. The AD works as a living will. First of all, it allows one to choose a surrogate. This person can select the type of treatment for the ADs maker if he or she cannot do that because of being incapacitated (NHPCO, 2017). One individual can appoint two surrogates, the original and the alternative one. Both can perform the same number of responsibilities in the order of succession. For instance, they can decide to withhold treatment if they believe that this action corresponds to the wishes of the ID. Therefore, it is essential to appoint people who clearly understand the makers values and preferences.
Secondly, an AD can include ones wishes to abstain from life-prolonging procedures, and preferences for organ donation. If this person is in a state where treating physicians do not believe there is a chance for improvement of the makers health, they can address the AD and make an appropriate decision. Furthermore, after ones death, the body or individual organs can be donated for research or transplantation. The maker can include various personal details about his or her health such as mentioning certain mental conditions and requesting or abstaining from specific treatments.
It was rather hard for me to complete the AD. First of all, as I did not know which situations I might encounter in the future, it was hard for me to assess all details of my mental and physical health. However, it was stated in the form that the AD could be redone frequently and replaced with a new version very easily, so I tried to think about my current health preferences. Second, the process of choosing a reliable surrogate was also difficult as it was a significant decision for my well-being. According to Silveira, Wiitala, and Piette (2014), the rate of people completing the AD is continuously growing. Many individuals become more aware of the legal side of the end of life care. Therefore, their relatives and friends also become more knowledgeable on the subject. While the idea of choosing a surrogate remains hard for many people, their general understanding of the issue eases this process.
Interestingly, some care providers working in hospice health care do not want to create an AD. According to Luck et al. (2017), many knowledgeable professionals who work with patients in need of constant care do not have ADs. It is possible that such reasons as the fear of discussing the subject and the demographics of these persons stop them from making ADs. In my opinion, such worries can be present in every person regardless of his or her occupation, because death can be considered a complex topic that is often avoided. However, the study by Silveira et al. (2014) finds that some people, especially older patients, are starting to treat the creation of ADs as a general and necessary topic of discussion.
The Physician Orders for Life-Sustaining Treatment (POLST) Form
The Physician Orders for Life-Sustaining Treatment (POLST) form is a combination of guidelines that a patient can fill to state his or her preferences for treatment. The form contains a number of sections that correspond with the patients state of health during an emergency. According to the National POLST Paradigm (2018), parts of the document can vary from one state to another, but their contents remain the same. Usually, the form has sections about Cardiopulmonary Resuscitation (CPR), levels of medical intervention, and artificially administered nutrition. The first section allows a person to deny CPR if he or she is completely unresponsive. The second part can give care providers some details about the patients preferences for life-sustaining treatment. One can ask to provide only comfort measures or request intensive methods. Finally, the information from the section about nutrition is utilized when the patient cannot eat.
This form should be completed if a person does not want to receive any of the services mentioned above. This individual should be old enough to have the autonomy and understand the implications of these actions. This form can be used by people who have severe health-damaging conditions and may become incapacitated. Also, people with religious beliefs can use this document to make sure that their values are being respected. In order to be considered a legal document, this paper should be signed by a healthcare professional, the maker of the form, or the surrogate of the maker. The acceptable types of professionals who can sign this document vary by state.
Conclusion
There are many differences between the AD and the POLST forms. The AD can and should be completed by everyone in order to make sure that their will is appropriately represented in a healthcare setting. On the other hand, a POLST form may be beneficial for persons whose health is very poor or deteriorating fast. Moreover, an AD can include ones preferences for hospice treatment and burial, while a POLST form contains actions connected to emergency situations and the sustainment of life. A POLST form is standardized, and an AD can include many personal details and suggestions from the maker.
A patient has the right to autonomy in choosing his or her treatment, and it is a duty of every medical professional to ensure that the patients needs are met. It is clear that RNs should follow the documents described above just as any other medical worker. Nurses should educate patients without ADs about their rights and possibilities. Moreover, they cannot make decisions that go against their patients wishes. It is vital to honor patients choices as they are directly connected to their life and its progression.
References
Luck, G. R., Eggenberger, T., Newman, D., Cortizo, J., Blankenship, D. C., & Hennekens, C. H. (2017). Advance directives in hospice healthcare providers: A clinical challenge. The American Journal of Medicine, 130(11), e487-e489.
National Hospice and Palliative Care Organization (NHPCO). (2017). Advance directives Florida. Web.
National POLST Paradigm. (2018). POLST paradigm form elements.
Silveira, M. J., Wiitala, W., & Piette, J. (2014). Advance directive completion by elderly Americans: A decade of change. Journal of the American Geriatrics Society, 62(4), 706-710.
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