Cheri L. Elson and Allen G. Drescher, Retired
21 S. 2nd St. ● Ashland ● Oregon ● 97520
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Advance Directives and POLSTs

I am often asked the difference between an Advance Directive for Health Care (ADHC) and a Portable Order for Life-Sustaining Treatment (POLST).  While both address end-of-life decisions, they do so in different ways.

An ADHC is a legal document in which a person states what health care measures they want if they are unable to communicate on their own.  An ADHC names a health care representative to speak to and direct the physicians in the place of the person creating the document.  In Oregon, we are mandated to use a specific form, which is basic to say the least.  However, we may supplement it so that it speaks to our personal desires and concerns.  ADHCs do not require a doctor or an attorney; it must be either notarized or witnessed by two adults, neither of whom are named as health care agents.  It may be changed or revoked at any time.  Everyone over age 18 should have an ADHC and they should be reviewed annually to ensure they remain current with one’s end-of-life decisions.

A POLST is a medical order completed with one’s primary care provider.  POLSTs address emergency situations in which a person may not be breathing or have no pulse, and both hospital personnel and EMTs will follow them in an emergency.  A POLST must be signed by a Health Care Professional (defined in the POLST itself) to be valid.  POLSTs can also become part of the Oregon POLST registry, allowing the medical orders in it to be accessed quickly in an emergency.  Typically, a POLST is completed by someone who is seriously ill or frail and toward the end of life.

Here is a table which sets out the differences between an ADHC and a POLST:

Advance Directive
A Voluntary Legal Document

A Voluntary Medical Order

For all adults regardless of health status at any age

For those with advanced illness, or frailty, or a limited prognosis at any age, depending on health status

1) Appoints a legal decision-maker
2) Memorializes values and preferences
3) Is signed by the patient

Is a specific medical order and is signed by a Health Care Professional

Provide for theoretical situations in which a person may not have capacity for decision making

Provides for likely events that can be foreseen

Guidelines for imagined future situations which may arise and for which a person may have preference for a particular kind of care plan

Specific medical orders addressing defined medical interventions for situations that are likely to arise given the patient’s health status and prognosis

Both documents are important and have a place in an overall estate plan.  Conversations with one’s medical and legal professionals will ensure that the appropriate documents are in place and end-of-life decisions are known and honored.

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Why an Estate Plan?

As we begin the last year of the decade, I thought it might be a good time to review just why estate planning is so important.

Estate planning is something most Americans avoid and often never get around to.  The excuses range from “Estate planning is too confusing” to “I don’t have anything to leave behind” to “I will get around to it next year.”  Having an estate plan, however, offers one’s family members peace of mind during a difficult period.

The four main documents in an estate plan are: Will, Trust, Durable Power of Attorney for Finances, and Advance Directive for Health Care.

A Will is a legal instrument permitting a person to make decisions on how their estate will be distributed after death.  With no Will, the person dies intestate and State laws dictate distribution of the estate.  Wills do not avoid probate; however, they will ensure your assets are distributed to the people and in the manner you desire.

One of the simplest ways to avoid probate is through a Trust.  In a conventional Trust, the three main “players” (Settlor, Beneficiary, and Trustee) are initially the same person. The Settlor never changes and is the only person who can change the Trust document. If the Settlor becomes unable to handle their own financial affairs the successor Trustee (chosen by the Settlor) takes over management of the Trust for the benefit of the Settlor, with the remainder beneficiaries receiving an interest in the Trust only after the Settlor’s death (the same way that a person’s estate passes to their beneficiaries under a Will).

The Durable Power of Attorney for Finances (DPA) names the person responsible for managing your personal finances in the event you are unable to manage them yourself.  Even in a Trust-centered plan, the DPA plays an important role, governing the assets held outside the Trust. 

An Advance Directive for Health Care combines a power of attorney for health care and a living will into one document.  It allows you to name an agent to speak with the doctors and make health care decisions for you if you are unable to make them on your own.

Estate plans are designed to grow and develop with us and should be reviewed periodically.  I recommend reviewing plans annually – changes may not be needed each year but reviewing the plan will help keep it fresh in your mind, as well as help ensure any necessary changes are caught and addressed quickly.

When properly drafted, an estate plan is a powerful tool not only in the event of person’s death, but also during one’s life.  Engaging the services of a professional who specializes in this area of law to assist you in drawing up your estate plan will help ensure your plan works effectively under any circumstances.

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