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H E A LT H L I N KS 1 2 | PULSE S u m m e r 2 0 1 6 H ave you completed an advance health care directive or living will? ese simple legal documents can provide you and your loved ones peace of mind by identifying what types of medical treatment you want (and don't want) and who is empowered to make health care decisions on your behalf in the event that you can't articulate those decisions yourself. Advance health care directives help plan for unforeseen medical emergencies, and they're recommended for just about everyone. But what about individuals for whom medical emergencies are not unforeseen, but imminent and likely … or individuals with serious or life-threatening conditions that may require emergency medical treatment within a year? People in such circumstances can "lock in" peace of mind with a Physician Orders for Life-Sustaining Treatment, or POLST form. An advance health care directive can address an individual's general wishes for medical treatment and name someone to act as a legal agent in making health care decisions, but POLST goes further—addressing the patient's specific wishes for CPR, artificially-administered nutrition and medical intervention. Once completed and signed by the patient and a physician, physician's assistant or nurse practitioner, the POLST form, as its name implies, has the weight of doctors' orders that medical professionals are required to carry out. Unlike an advance health care directive, POLST is not for everyone. It's for individuals facing situations that are "not if but when the next medical crisis occurs," says Mary Hersh, PhD, RN, Torrance Memorial Medical Center's palliative care program manager. "We understand that serious illness is not only an experience of the patient but also an experience for the family," Hersh says. Making health care decisions for a loved one is difficult. A directive or POLST can help. Attorney Eric J. Harris, a specialist in estate planning , trust and probate law, and a member of Torrance Memorial's professional advisory council, adds that advance health care directives are not always immediately available to emergency medical personnel. In contrast, POLST forms, typically printed on bright pink paper, are designed to be placed so they're easily accessible to first responders—on a refrigerator, say, or in a purse or glove box. If an advance health care directive or POLST is not available, physicians try to find the patient's closest legal agent or next of kin, which may prolong unwanted medical treatment. Both are relatively simple documents and do not require an attorney to complete. "ere's no good reason not to have an AHCD and a POLST," says Harris. POLST forms are available from Torrance Memorial's Care Coordination Center, which provides post-discharge care to patients and families. Contact Sasha Mejia, NP, at 310-784-8713. The form can also be downloaded from the Coalition for Compassionate Care of California at capolst.org. PEACE OF MIND WRITTEN BY JOHN FERRARI RATHER THAN LEAVING LOVED ONES TO GUESS ABOUT A PATIENT'S WISHES, HAVING AN ADVANCE HEALTH CARE DIRECTIVE GIVES THEM THE COMFORT OF KNOWING THEY'RE CARRYING OUT WHAT THE PATIENT WANTS. DISCUSSING LIFE VALUES WITH LOVED ONES Discussing end-of-life decisions can be an uncomfortable conversation but especially for individuals likely to face a life decision in the near future. Those for whom POLST is recommended may find such a conversation can be life-affirming. Everyone eventually will pass on, notes psychologist Dana Hodgdon, PhD, Torrance Memorial Hospice's bereavement coordinator, and most people would like their end-of-life decisions to reflect their attitudes toward life. Taking the time to have conversations with loved ones and completing an advance health care directive (AHCD) and, if appropriate, a POLST form, can give individuals a measure of control over how they pass on, ensuring their passing is in keeping with how they lived their lives. Discussing advance health care directives and POLST can be part of a larger, ongoing conversation about life values and what's important to the individual, family members and other loved ones involved. Having these conversations before they're needed lessens stress levels later on, but even when discussions about end-of-life decisions happen out of immediate necessity, it's much better to have them than not. "Not ever having had the conversation," says Dr. Hodgdon, "that's the nightmare scenario." Having a discussion—and completing an AHCD and POLST form— gives loved ones the comfort of knowing they're carrying out what the patient wants and the legal ability to do so. "So many people are so averse to even discussing these topics," says Hodgdon. "But it's really important." A document called Five Wishes is an effective tool for facilitating discussions about end-of-life issues. It is available at agingwithdignity.org.