California Medical Decision Making Forms: Advance Directives, DNR and POLST

In California, the advance directive serves the function of what is sometimes referred to as a "living will" or "power of attorney for healthcare."  It is composed of two basic parts:

1. Designation of a healthcare decision maker (this is the "power of attorney" concept).
2. Specific instructions by the person filling out the form about the care s/he wants (this is what people ususally mean by "living will").

A person may complete either or both parts of the form.  The form also includes the option to express wishes about the donation of organs and tissues, and the option to designate a primary physician.  There are signature and witness requirements that vary depending on whether or not a person is in a skilled nursing facility.  Any person over the age of 18 that has legal capacity can  complete an advanced directive. 

The Physician Orders for Life Sustaining Treatment (POLST) and pre-hospital Do Not Resuscitate (DNR) forms are medical orders--they are signed by a physician.  Neverthless, attorneys that deal with health or elder issues should be aware of them.  They are intended to supplement advance directives; they provide specific instructions for medical personnel about certain treatments.  Unlike an advance directive, which even healthy adults may want to prepare in case of unexpected accident or illness, they are normally intended for people with serious terminal illnesses, or who are frail and near the end of life.

The Patient Self Determination Act (PDSA) requires certain facilities that participate in the Medicare and Medicaid programs to notify patients about their rights to engage in health care decision making, and the facility's policy regarding advance directives.  The facilities must also document it in the medical record if a patient has an advance directive, and the facility may not discriminate against a patient based on whether or not s/he does.

Also, note that under Federal law, members of the active military and some others with advance directives may not be subject to state law requirements (e.g., formality requirements) for advance directives. (10 USC Secs. 1044, 1044c.)

Before preparing an advance directive and/or a POLST, people should think through their preferences and values carefully to be sure that the documents reflect their wishes.  The resources below are designed to help with this process, and with the process of helping to communicate those wishes to the healthcare decision maker (also called the "agent," "proxy," or "surrogate").

The links below are meant to give basic background about end of life issues.  A number are from MedlinePlus, which is a consumer health website from the National Library of Medicine and the National Institutes of Health.