Question

Mrs. A, a 76-year-old widow with Alzheimer disease, lives with her daughter. She cannot be left alone safely because she sometimes forgets to turn off the stove or wanders away. When she was still lucid, she told her children and her friends many times that she wanted "no heroics" if she became senile. After visiting a neighbor who was in a nursing home, poorly responsive after a severe stroke, she told her son, "That is not living. I would never live in a nursing home, unable to recognize my family and depending on others to take care of me. The smell is terrible. If I'm like that, just let me die in peace." She signed a POLST form, specifying that she did not want to be resuscitated or hospitalized (except if needed for comfort measures), but it was not signed by a clinician or entered in her health record. She also wrote by hand NO SURGERY-NO INTENSIVE CARE, on the form. 8 Mrs. A's children cannot afford to pay an attendant during the day while they are at work. Adult day health .programs were cut back and are not available. Unable to care for Mrs. A safely at home, her children reluctantly consider placement in a nursing home. Question: Does Mrs. A have a valid advance directive (if so which, if not should her children execute one for her) and can she be placed in a nursing home against her wishes?

Answer 1

Advance Directives are legal documents that specify a persons wishes before hospitalization and provide valuable information that may assist health care providers in decision making.A living will is one type of advance directive .In most situations ,living wills are limited to situations in which the patients medical condition is deemed terminal.Because it is difficult to to define terminal accurately ,living wills are not always honored.Another potential drawback is that living wills are frequently written while people are in good health.it is not unusual for people to change their minds as their illness progresses,therefore ,patients retain the option to nullify these documents.Here the patient is having a POLST form ,which summarizes the patients wishes in the form of medical orders and patients maybe held to their choices many years after their preferences have changed.So definitely she is having a POLST form which is more effective.it complements an advance directive.But unlike an advance directive POLST must be signed by both the patient and the attending physician,nurse practicioner or physician assistant-certified.Here the patients POLST form is not signed and hence it is not valid.POLST is said to be operational as soon as it is completed and signed by the patient or surrogate regardless of the patients decisional capacity when treatment decisions become necessary.