A POLST is for people who have already been diagnosed with a serious illness. This form does not replace your other fonts. Instead, it serves as a doctor-prescribed guide — similar to a prescription — to make sure you get the treatment you prefer in an emergency. Your doctor will fill out the form based on the contents of your living wills, conversations you have with your doctor about the likely course of your disease, and your treatment preferences. You should discuss the changes with your GP and ensure that a new policy replaces an old policy in your medical record. New guidelines must also be added to the medical records of a hospital or nursing home. Also talk to your doctor, family, and friends about any changes you`ve made. Living wills, whether oral or written, advisory or a formal document required by law, are tools that give patients of all ages and health conditions the opportunity to express their values, care goals and treatment preferences to guide future health care decisions. Living wills also allow patients to identify who they want to decide on their behalf when they can`t do it themselves. They allow physicians and surrogates to make a good faith effort to respect the patient`s goals and implement the patient`s preferences when the patient has no decision-making capacity.

At some point, most clinicians meet with patients with a living will, which usually includes specific instructions about the course of treatment the health care provider should follow. In some cases, a living will may prohibit financially burdensome medical treatment. It can also express the patient`s wishes regarding the supply of food and water via feeding tubes or intravenous fluids. A living will is only used if the person is unable to give informed consent or refuse due to incapacity for work. A living will can be specific or very general. [7] [8] [9] The overwhelming effect of the Cruzan decision was to strengthen the constitutional basis of the right to refuse life-sustaining treatment. The recognition of such a constitutional right reinforces the validity and weight of all authentic expressions of patients` wishes. The most difficult constitutional issue for political purposes remains the extent to which states can dictate procedural safeguards in the advance care planning process, both in the manner in which individuals express their wishes and in the empowerment of substitute decision-makers.

There are differences in precautionary laws in different countries. Many states now have medical prescriptions for life-sustaining treatment (POLST), medical prescriptions for life-sustaining treatment (MOLST), medical prescriptions for scope of treatment (MOST), doctor`s prescription for scope of treatment (POST), do not resuscitate/clinician prescriptions for life-sustaining treatment (DNR/COLST), Transportable medical prescriptions for patient preferences (TPOPP) or similar guidelines that outline the key points of the living will in the form of a medical prescription. put. [1] [2] [3] For the sake of brevity, the term POLST is used for all these variations in the rest of the article. In emergency situations where a patient is unable to participate in treatment decisions and no surrogate mother or living will is available to make decisions, physicians should perform medically appropriate interventions when urgent to meet the patient`s immediate clinical needs. Interventions may be withdrawn at a later stage, depending on the patient`s preference, when known, and in accordance with ethical guidelines for treatment discontinuation. States have required various types of legal formalities for the enforcement of living wills: A third wave of laws began in the early 1990s, triggered by a growing awareness of unwanted resuscitation of terminally ill patients living at home or in a hospice when the expected medical crisis occurs and someone calls 911 locally. In the absence of a resuscitation protocol in the hospital, emergency responders are required to make every effort to resuscitate a patient whose heart or breathing has stopped, unless the patient himself refuses help. A living will generally does not override this obligation.41 To counter these unwanted medical encounters, states began passing laws or regulations in the early 1990s to allow critically ill people in the community to avoid unwanted resuscitation by using DNR orders outside the hospital (sometimes as an attempt at non-resuscitation). comfort care orders, cardiopulmonary resuscitation (CPR) guidelines or other names). These protocols most often required the signing of a DNR order by both the physician and the patient (many states allow a surrogate to sign) and the use of a specially designed identifier that had to be kept on or near the patient.

The protocols effectively created a kind of hybrid special advance directive and portable physician mandate. At the end of 1999, 42 States had national protocols, most often created by legislation. The POLST paradigm has the added advantage of being quite adaptable to the variable law of the state. For example, it has been implemented both with legislation (as in West Virginia114) and without legislation through vendor collaboration (as in Oregon115). To the extent surrogates are allowed to make health decisions under state law, surrogates can fill out POLST forms. POLST paradigms can be implemented at the national and/or local level, depending on legal and clinical susceptibility. Although POLST is a paper-based protocol, it can be adapted to electronic health record environments. The main limitation of forward planning is that it necessarily focuses on immediate potential decisions rather than goal-oriented remote planning.