How to manage your end-of-life wishes?

Dr. Richard Feldman for – Advanced directives are an important set of legal documents that communicate one’s wishes for treatment during life-limiting or terminal illness. They’re designed for use when one is unable to communicate those wishes or are no longer mentally competent to do so.

We rely on a number of advanced-directive documents. The living will provides people with the ability to determine one’s wishes concerning the use of life-prolonging interventions such as CPR, artificial nutrition and ventilator care during a terminal illness. A person may not wish to have anything done other than comfort measures to allow a natural death or may want all life-sustaining medical treatments. It is the individual’s choice.

The out of hospital do not resuscitate declaration is mostly relevant during an emergency or when a terminal patient dies at home. This order directs emergency medical services to refrain from performing CPR or advanced cardiac life support measures during a cardiopulmonary arrest. Otherwise they are required to do so.

The durable power of attorney and the appointment of a health-care representative designate an individual to make decisions regarding medical care when one can’t do so because of an inability to communicate or in the event of mental incompetence.

But these documents are not totally effective in ensuring patient treatment wishes are honored at the end of life. They are sometimes unavailable or unknown to health-care providers in critical situations. They are often vague and open to interpretation by family members and appointed health-care representatives.

Now, Indiana has joined 19 other states in the adoption of the Physician Orders for Scope of Treatment, which was enacted by the General Assembly in 2013. POST is not necessarily a replacement for existing advance-directive documents but an enhancement. It has been demonstrated in other states that POST better assures that one’s wishes for end-of-life medical care are honored.

The central component of the Indiana law is the POST form, which addresses the use of CPR. Individuals also may designate treatments that manage symptoms while allowing a natural death. It also includes an option to limit interventions for stabilization of a medical condition.

It is important for the public to recognize that this form of advanced directive is now operational in Indiana. Health-care providers and facilities must also become familiar with the new law and create protocols to assure their proper use. POST is a great advancement in end-of-life care in Indiana.

Feldman is director of medical education and family medicine residency at Franciscan St. Francis Health. He is a former Indiana state health commissioner. Email him at

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