Q : I heard you speak recently and you said that “everyone over age 18 should have a will, power of attorney for finances and an Advance Health Care Directive.” I have those documents and have a Physician Orders for Life-Sustaining Treatment as well. Do I need both a POLST and an AHCD?

A: The short answer is that if you are seriously ill and would not want to be resuscitated in a medical emergency, then you should have both documents. A POLST is a voluntary form you complete with your physician and is normally completed by patients who are seriously or terminally ill or otherwise medically frail. Unlike the Advance Health Care Directive, the POLST speaks for you whereas the AHCD appoints an agent to express your wishes about health care as you have outlined in the document. Only the POLST, and not an AHCD, can include instructions not to resuscitate. The AHCD is not a “Do Not Resuscitate” document and does not contain a do not resuscitate order. If you are gravely ill and do not wish to be resuscitated, work with your physician to complete a POLST and post it at home. You can also put a copy in your wallet, glovebox of your car, and provide copies to the local hospital.

The POLST, well known for the bright pink paper it is printed on, can also be completed by nurse practitioners and physician assistants (under the supervision of a physician). If you have a POLST, it is recommended that you post it on your refrigerator at home or other locations that would be readily seen by an EMT if an ambulance is called on your behalf. Absent a POLST, an EMT is required to administer life-sustaining treatments such as cardiopulmonary resuscitation.

A client told me that twice the EMTs had been to her house and, despite the fact that she had a POLST stating do not resuscitate, both times the EMTs resuscitated her. The problem was she kept the POLST in a dresser drawer rather than posting it in a place where the EMTs would easily see it. She hated the way “it sticks out and all my friends will see it!” Finally, she was so frustrated that she took a permanent marker and wrote “DNR” in bold black letters on her chest!The POLST becomes part of your medical file at the hospital and, ostensively, if you are in a different county and a medical event occurs, the EMT in that county should have access to it.

However, if you think about it, unless it is obvious to the attending EMT that your POLST states do not resuscitate, they will take life supporting measures. In our litigious society, it is easier to say they did not easily find a POLST than fight a lawsuit for negligence.

Completing an AHCD or a POLST can be challenging. While both documents provide some guidance in what choices are available and your physician can help with the POLST, it is impossible for any of us to know what emergency or health care challenge will arise in our future and how we would want it addressed. This, however, should not keep you from preparing the documents. Prepare them based on today’s situation and update with a new document if your medical condition changes or your feelings alter regarding certain medical care.

With the AHCD where you nominate an agent to represent you, have ongoing talks with your agent to be sure they understand and are comfortable with your wishes. I have a friend who elected her sister as her agent. My friend did not want her life prolonged if she had an incurable and irreversible condition that would result in her death within a relatively short time. Her sister began to argue with her about all the advances being made in medicine and that there could be a cure developed that would save her. It became clear to my friend that she had named the wrong agent.

So, yes, the AHCD is an important document to have in your estate plan but consider adding a POLST if you are critically ill or otherwise frail. A client expressed it beautifully to me, “I have had a beautiful and full life. I feel complete. My husband and all other family are gone and, well, I’m just ready!” Needless to say, a bright pink document hangs on her refrigerator.

Liza Horvath has over 30 years of experience in the estate planning and trust fields and is the president of Monterey Trust Management, a financial and trust management company. This is not intended to be legal or tax advice. If you have a question call (831)646-5262 or email liza@montereytrust.com