The Importance of Clear Medical Directives
- Sarah Spilman
- 6 hours ago
- 4 min read
Every year, National Healthcare Decision Day reminds us of a critical yet often overlooked aspect of healthcare: making our medical wishes known before a crisis occurs. When faced with sudden illness or trauma, clear communication about treatment preferences can guide healthcare providers and loved ones through difficult decisions. This advanced planning matters, and documents like the Physician Orders for Scope of Treatment (POST) help ensure your wishes will be respected.
Why National Healthcare Decision Day Matters
National Healthcare Decision Day, observed annually on April 16, encourages people to think about and document their healthcare preferences. Many avoid this topic because it feels uncomfortable or distant, but emergencies can happen to anyone at any time. Without clear instructions, medical teams and families may struggle to decide on treatments, which can lead to confusion, stress, or care that doesn’t align with the patient’s values.
When a person is seriously ill or injured, healthcare providers need to know what treatments to offer or withhold. Clear medical wishes help avoid unwanted interventions or delays in care. For example, some people may want all possible life-sustaining treatments, while others may prefer comfort-focused care if there is no chance of meaningful recovery. Without documented wishes, providers often default to aggressive treatment, which might not reflect the patient’s desires. This can cause emotional distress for families and may prolong suffering.
Types of Advanced Planning Documentation
There are three main types of documentation that can be used to communicate your wishes, but they have distinct purposes and work in tandem.
Advanced Directive
An Advanced Directive is a legal document that allows you to specify your medical treatment preferences and appoint a trusted person (healthcare proxy) to make healthcare decisions on your behalf if you become incapacitated. This document covers a broad range of situations, such as life-sustaining treatment, pain management, organ donation, and other medical decisions.
The Advanced Directive is often written by your lawyer during estate planning, but it can also be downloaded and completed by you without a lawyer as long as you follow your state's requirements for notarization and witnessing of signatures.
Physician Orders for Scope of Treatment (POST)Â
The POST is a medical document created with your doctor that records your treatment preferences. It is designed to be easily understood and followed by healthcare and trauma teams across different settings, such as hospitals, nursing homes, or emergency services. Unlike a general advance directive, a POST form translates wishes into actionable medical orders. This means that emergency responders and doctors know exactly what treatments to provide or avoid, specifically related to resuscitation, intubation and mechanical ventilation, artificial nutrition and tube feedings, and other life-sustaining treatments. It is critical that people who are seriously ill, frail, or near the end of their lives have this document in a prominent place so it can be easily found by family or EMS providers when needed (e.g. hung on the fridge by a magnet).
Each state has its own POST. For example:
In Maryland, the document is referred to as Maryland Medical Orders for Life-Sustaining Treatment (MOLST)
In Iowa, the document is referred to as Iowa Physician Orders for Scope of Treatment (IPOST)
In California, the document is referred to as California Physician Orders for Life-Sustaining Treatment (CPOLST)
Code Status
Medical code status guides emergency treatment during hospitalization and typically is categorized as Full Code (all interventions), Partial Code/Limited Intervention (selective interventions), and Do Not Resuscitate (DNR) (no interventions). The care team will document the code status of every admitted patient, particularly older adults and patients with any acute or chronic life-threatening illness. If a patient is admitted and the code status is already in the medical record from a previous hospitalization, it will be re-reviewed with the patient and/or family representative. Code status can be derived from the Advanced Directive or POST and can be modified or revoked at any time by patients or their representatives.
How to Prepare and Communicate Your Medical Wishes
Preparing your medical wishes involves more than filling out forms. It requires thoughtful reflection and open communication. Here are practical steps to get started:
Reflect on your values and goals
Consider what quality of life means to you and what treatments you would or would not want in different scenarios.
Talk with your loved ones
Share your wishes with family or trusted friends so they understand your preferences and can support you.
Consult your healthcare provider
Discuss your wishes with your doctor, who can help explain medical options and assist with completing a POST form or advance directive.
Complete and share your documents
Fill out the necessary forms, sign them according to your state’s laws, and distribute copies to your healthcare providers, family, and keep one accessible for emergencies. It is best to proactively provide the forms to your healthcare provider so they are scanned into your electronic medical record and visible immediately in the case of emergency.
Review and update regularly
Revisit your wishes periodically or after major life changes to ensure they still reflect your values.
Real-Life Examples of the Impact of Clear Medical Directives
Consider the case of an elderly woman who suffered a fall in her care center and was unable to communicate her wishes. If she has a POST form indicating she does not want aggressive life support, the medical team will focus on comfort care, respecting her wishes and sparing her family from difficult decisions.
In contrast, an elderly man without documented wishes was admitted to the hospital after a severe motor vehicle accident. His family was unsure about his preferences so they opted to pursue aggressive measures, leading to intubation, prolonged intensive care, and emotional distress.
This example shows how clear instructions can ease the burden on loved ones and medical teams.
Encouraging Everyone to Take Action
National Healthcare Decision Day is a call to action for everyone, regardless of age or health status. Emergencies can happen unexpectedly, and having clear medical wishes benefits not only the individual but also their family and healthcare providers.
By planning ahead, you gain control over your care and provide peace of mind to those who may need to make decisions on your behalf.