What are the main types of advance directives?

The main types of advance directives are the health care power of attorney and the living will. Medical orders for life-sustaining treatment (MOLST) forms are another way to communicate your wishes.

What is a health care power of attorney?

A health care power of attorney is a legally binding document that permits you to name a health care agent (sometimes called a health care proxy) to make medical decisions on your behalf if you are unable to make them yourself.

All adults should designate a health care proxy. Older adults (over age 55) or people who have serious, progressive illnesses should revisit the process whenever their health status changes significantly.

Why appoint a health care agent? If you havenít chosen anyone, a relative or court-appointed guardian may be asked to make medical decisions for you. That person might not know your wishes or might not be comfortable following them. And if more than one close relative is at your bedside, the doctor may want all of them to come to a consensus before following any of their instructions. Itís best if youíve already appointed one person to handle medical decisions using your wishes as a guide.

Generally, both law and medical ethics dictate that your health care agent must make decisions that he or she thinks you would have made. You can explain your wishes in advance through conversations or by writing them down, or both.

What is a living will?

A living will is a document that allows you to describe your goals for medical treatment, your religious or spiritual beliefs, and any guidance you wish to give regarding your medical treatment in various scenarios that may arise. This written record guides your doctors and loved ones in caring for you, should you ever be unable to communicate those wishes directly. Often, itís used to determine how aggressive you would like your medical treatments to be as the end of life nears.

What are medical orders for life-sustaining treatment (MOLST)?

If you are seriously ill right now, you can help ensure that your goals and wishes for treatment will be honored if you are unable to speak for yourself when a medical decision needs to be made. Medical orders for life-sustaining treatment (MOLST) is a medical order signed by your doctor after discussion with you or your health care agent about your desires for care. In some states, MOLST may go by the acronym POLST (physician orders for life-sustaining treatment), POST (physician orders for scope of treatment), or MOST (medical orders for scope of treatment). Regardless of the name, the approach is the same.

Using a MOLST, your wishes will have the authority of a physician-written medical order that is portable and effective across care settings. Thus, your wishes can guide treatment in an emergency as well as care you receive in the hospital, at a nursing facility, or at home.

Click here to access the Massachusetts MOLST forms.

Click here for a printer-friendly version of this table.

If you have more questions or need help completing your advance directive, contact your health care provider.

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