Considering each individual’s choices, whether full treatment, comfort measures, or something in between, is difficult but essential to ethical end of life care decisions. Such decisions become even more difficult once patients become unable to communicate clearly. (When decisions need to be made at the end of life, 70% of patients lack decision making capacity). Therefore, it is highly desirable for most people to discuss end of life care options and document personal choice well in advance of the final stage of life. Evidence shows that conversations about end of life care options among physicians, patients and their loved ones can improve the quality of life of dying patients.

Three main choices may be documented in advance care plans:

  1. Resuscitation efforts you do or do not want in an emergency (documented only in POLST)
  2. Intensity of medical treatments you prefer to have or not (documented in Oregon Advance Directive and/or POLST)
  3. Appointment of a “Health Care Representative” to make decisions for you when you are unable to speak for yourself (documented only in Oregon Advance Directive)

Recommended time to complete an advance directive or POLST

  • Oregon Advance Directive
    • When you make plans for the rest of your life, ideally by age 60
  • Physician Orders for Life Sustaining Treatment (POLST)
    • When you first know you have a serious illness
    • When you would not be surprised if you died within the next year
    • When you strongly desire limited interventions
  • Important to complete both forms
    • When you are able (before you lose capacity, which is often unpredictable!)
    • Before the final stage of life

What happens without an advance care plan

Your choices can be honored only if they are known. Without documentation of your preferences, healthcare providers are required by protocol to begin the most aggressive interventions available in a medical emergency. These include:

  • Electrical shock to your heart
  • Cardiopulmonary resuscitation (CPR)—vigorous compressions to your rib cage
  • Life-support machines to help you breathe
  • “Tube-feeding” to provide nutrition and hydration