Advance Directives
For most of us, end-of-life planning seems like something we can do later. However, now is the perfect time to learn about Advance Directives, along with other documents that make your healthcare wishes clear. Advance Directives can ensure that you get the care you want when you can’t speak for yourself. They can also help your loved ones understand what is most important to you – not just at the end of life but in any healthcare crisis.
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What is an Advance Directive?
Advance Directive is an umbrella term that generally includes two important documents: your Living Will and Medical Power of Attorney. You complete these documents while you are able to make your own medical decisions. You then sign them along with two adults who witness your signature. The documents are used to express your healthcare wishes if you’re no longer able to make these impactful decisions yourself or tell your providers, caregivers, or loved ones.
Advance Directives help ensure you have the quality of life you envision, and they spare your loved ones from having to make certain decisions for you. An Advance Directive:
- Specifies the types of treatments you want or don’t want at the end of life or whether you want to participate in organ donation
- Allows you to appoint someone as your healthcare agent, who’s legally authorized to make decisions about your healthcare if you’re unable to make them yourself
An Advance Directive outlines your choices for decisions about possible health-related circumstances that could come up in the future.
For More Information
You can learn more and download forms at:
Living Will
Your Living Will tells your healthcare team which treatments you do and do not want used to keep you alive. These could include CPR, a breathing machine, or artificial feeding. You can also state your preferences about organ donation, pain management, and other issues. Your Living Will is used when the healthcare team feels you may be very near the end of your life. It is a signed, legal document that the healthcare team must consider when deciding on your care. However, medical providers who aren’t familiar with your wishes and values may interpret certain terms differently than you intended. That makes your Medical Power of Attorney very important.
Medical Power of Attorney (MPOA)
With this document, you designate someone to become your voice for medical decisions when you are too ill to speak for yourself. Talk with this person, called your healthcare agent or medical proxy, about which treatments you want and don’t want at that time. It is a legally binding document, and the healthcare team must comply with your proxy’s decisions. You can also choose an alternate in case your proxy is unable to serve. You don’t need to be terminally ill to create a Medical Power of Attorney – it’s important for every adult. If you do NOT have this document, your healthcare decision makers will be determined based on Montana law in this order: your spouse, then adult child(ren), parent(s), sibling(s), other relatives by blood or adoption.
Other Advance Care Planning Documents
Five Wishes
The Five Wishes document is a more comprehensive Advance Directive that lets you combine your Living Will and Medical Power of Attorney along with three additional directives centered around your personal, emotional, and spiritual needs. The Five Wishes document extends beyond your medical wishes to cover all of your end-of-life choice. It can better prepare you for the completion of a POLST (see below) when needed.
The Five Wishes are:
- Wish 1. The person you want to make care decisions for you when you can’t – Medical Power of Attorney.
- Wish 2. The kind of medical treatment you want or don’t want – Living Will.
- Wish 3. How comfortable you want to be. This addresses the type of pain management you would like, as well as your choices about personal grooming, bathing, hospice, and others.
- Wish 4. How you want people to treat you. Here you can state your choices such as whether
you want to be at home, who you want close by, and whether you want someone to
pray at your bedside.
- Wish 5. What you want your loved ones to know. It includes your wishes about funeral or
memorial plans, how you want to be remembered, and any messages of forgiveness.
Provider Orders for Life-Sustaining Treatment (POLST)
In addition to your Advance Directive, there is another medical order you should be aware of: the POLST. Your POLST works together with, not instead of, your Advance Directive. It ensures that you get the care you want during a medical emergency.
A POLST is a medical order from an approved medical provider such as a physician, advanced practice registered nurse, or physician assistant. This provider works with you to create an order that is followed by emergency medical services (EMS), first responders, and emergency room staff. Your Advance Directive can serve as the basis for your POLST. Both you and your provider must sign a POLST for it to be valid in Montana. If you are unable to sign, your healthcare proxy can complete your POLST with your provider.
If you have a serious illness or are near the end of life, talk to your provider about your choices for emergency care and have them complete a POLST. You can have the POLST added to your electronic health record at Benefis. You will keep the original. It’s also a good idea to display your POLST document where emergency medical personnel who come to your home can easily see it, such as on your refrigerator.
Your POLST form expresses preferences that are appropriate for your current health condition—unlike an Advance Directive that providers guidance for situations that may occur in the future.
Download POLST Form
Other Legal Documents to Consider
With advance planning, it’s important to complete other legal documents such as a Last Will and Testament and a Power of Attorney for Financial Matters. Your healthcare team does not routinely help with these documents, and it’s best to consult a lawyer to ensure that they are done correctly.
When Your Priorities Change
Your Advance Directive and other healthcare documents can be changed at any time. A good way to think about updating these documents is through trigger points called the Six Ds.
Consider updating when a:
- Decade in age is reached.
- Death of a loved one is experienced.
- Divorce takes place.
- Diagnosis of a serious health condition is received.
- Decline in your functional condition happens.
- Domicile or living situation changes, such as someone moving in with you.
Where do I Get the Forms? Then What?
These documents are available through Benefis chaplains, in hospital or outpatient areas, or through consultation with the palliative medicine team. You can also find electronic versions on the Benefis website. Ask your primary care provider about forms you can use, or visit the links at the end of this page to download them yourself.
You can complete your advance care planning documents on your own, except for the POLST, which requires a medical provider. You don’t need an attorney’s help even though they are legally binding.
Give copies of your signed and completed Advance Directive to your family members and primary care provider, and take one with you if you are hospitalized.
You can also store your Advance Directive with Montana’s End-of-Life Registry at www.dojmt.gov/consumer/end-of-life-registry. It’s best to bring these documents with you if you come to the hospital or emergency room.
Please also provide your advance care planning documents to Benefis Medical Records.
Mail copies to:
Benefis Health System
Medical Records Department
1101 26th Street South
Great Falls, MT 59405
