George had told his entire family many times that when death came for him, he wanted no heroics to try and “save” him. He had been dealing with congestive heart failure for years and life was becoming more and more difficult.

That day arrived when George’s friend, Hal, found him lying on the kitchen floor, unresponsive. Hal immediately called 911, not knowing what else to do. When the paramedics arrived, CPR was begun immediately and a defibrillator was used to start George’s heart, at which point he was rushed to the hospital in the ambulance and admitted to the cardiac care unit.

George’s family informed the hospital that George had specifically said he wanted no heroics if his heart should fail. The nurse asked if George had a Physician’s Orders for Life-Sustaining Treatment (POLST) form, which would have informed both the paramedics and the emergency department of George’s wishes. George’s son said he didn’t think so, but George had told all the family what he did and didn’t want. It was also determined that George had no Advance Directive and no health care representative appointed to make medical decisions for him now that he was unable to speak for himself.

The family kept assuring the staff that George didn’t want to be tube fed or on a ventilator but, in the absence of a POLST and advance directive, the hospital was obliged to try every life-sustaining measure. George’s family was distraught with the fact that George’s wishes were not being carried out.

All the distress and unwanted treatment could have been avoided if only George had done as his doctor encouraged him to do every time George was in his office — execute an advance directive and a POLST indicating specifically the kind of treatment George did and did not want to receive in case of an emergency and if he was dying.

Perhaps you want everything possible done to keep you going or maybe something in between. Whatever you desire, it must be documented.

Every competent adult, not just those with a serious illness, should have an advance directive, which allows you to document your wishes concerning medical treatment if you are close to death. It also grants a medical power of attorney to someone you choose to act as your health care representative, who is authorized to make medical decisions on your behalf when you can’t.

The advance directive only goes into effect when your doctor determines you are unable to make or communicate your health care decisions and you are close to death, permanently unconscious, have an advanced progressive illness, or if life support would cause extraordinary suffering.

While a lawyer is not needed to fill out an advance directive, it becomes legally valid as soon as it is signed by you in front of two required witnesses. No doctor’s signature is required although you certainly want to provide a copy for your medical records.

It’s wise to secure the documents for each state in which you may receive health care, as the forms and laws may vary from state to state. Talk with your family and friends about the advance directive and be sure they understand exactly what your wishes are for care at the end of your life. Discuss with your health care representative your values and beliefs and what you consider to be an acceptable “quality of life.”

As important as preparing an advance directive is where you store it. First, make copies of the completed documents to give to your health care representative and an alternate, if you select one. Also provide copies to your doctor and everyone who might be involved with your health care, such as family, friends, and clergy.

Do not keep the original of your advance directive in a safe deposit box. Be sure it is in a safe but easily accessible place. Tell others where it is; you can note on the copies the location of the original. There are services available that will store copies of your documents and can make them available on your behalf. MedicAlert and U.S. Living Will Registry are two such services.

Advance directives do not expire but may be revoked at any time and in any manner by which you are able to communicate your intent to revoke it. An advance directive will be automatically revoked if you execute a new one. Because situations and health issues change, the advance directive should be reviewed on a regular basis to be sure it still reflects your wishes.

Also included in the Oregon advance directive packet is an Oregon organ donation form on which you can indicate your intention to donate any needed organs, tissue and eyes, or just specific organs. Registry is also possible online through Donate Life Northwest or you may register when you renew your Oregon driver’s license.

This is another instance where your family needs to be aware of your registration and desire to be a donor, so that the proper procedures are followed at the time of death.

Unlike the advance directive, the POLST is only for seriously ill or frail patients for whom their health care professional would not be surprised if they died in the next year. For these patients, their current health status indicates the need for standing medical orders for emergent or future medical care.

The doctor identifies and discusses with the patient their specific diagnosis, prognosis, and treatment options. The patient shares their values, beliefs, and goal of care. Using all that information, the doctor and patient together make decisions about desired treatments. The physician completes the POLST and signs it.

The Oregon POLST is printed on bright pink card stock and should be posted on the front of the refrigerator where it is easily seen by emergency medical personnel. If a POLST is available, medical personnel will abide by its instructions. If no POLST is evident, emergency medics, by law, must do everything they can to resuscitate or stabilize a person and get them to the hospital, regardless of what their unwritten wishes might be. There is also a statewide POLST registry accessible by all medical facilities.

Emergency medical personnel cannot honor an advance directive. After they get a person to the hospital and a physician fully evaluates the person’s condition and determines the underlying conditions, the advance directive can be implemented.

The advance directive and the POLST are both voluntary. They both document patient treatment preferences and goals of care. However, according to an article in the Journal of the American Geriatric Society, “Clinical experience and research demonstrate that advance care directives are not sufficient to ensure that care goals of patients with serious advanced illnesses will be honored unless a POLST form is also completed.”

Had George posted a POLST form in his home, the medics would have been able to honor his wishes regarding no resuscitation. At the hospital, an advance directive would have guided the staff in honoring George’s wishes and relieved his family of their distress regarding his wishes.

Oregon Advance Directive forms are available online, at your doctor’s office, and from any hospice. Your physician has POLST forms and they are available online.