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TroveStreet® Wisdom: Documenting Wishes - Advance Directives

What would happen if you couldn’t speak for yourself as the result of a serious accident or sudden unexpected illness like a heart attack or stroke, and a medical decision needed to be made? Who have you chosen and documented to make decisions for you?

When the time of death nears for whatever reason, most people want the experience to be as peaceful and painless as possible. This is not only true for the person dying, but also for the family members or loved ones who are caring for them and who will remain.

Yet many don’t take the time — while they can — to reflect, discuss, and document their wishes. Instead of having meaningful and cherished conversations about illness and death with family or loved ones in the comfort of their home, decisions are made during a time of crisis and stress.  Too often, in an ICU of a local hospital.

This is why Advance Care Planning is so important.   It ensures your wishes for how you want to be treated throughout your phases of health, illness, and death are documented.  These documents are used by family and health care team when you are unable to speak for yourself.

Here’s what you need to know to make decisions and have important conversations in advance of a health crisis:

Advance Directives

A Living Will and a Durable Power of Attorney for Health Care documents are also called advance directives.

Living Will

A Living Will documents your wishes for life support, medical treatments, and the level of care that you would want in an end-of-life situation. Two doctors must determine that you are unable to recover from your condition and that death is imminent.

The Living Will determines if you do or do not wish to have life support such as CPR, intubation and ventilation, tube feeding, or on-going dialysis.  If you do not have a living will specifying your wishes, full aggressive treatment is mandated and may not be what you would want in the situation.

Durable Power of Attorney for Health Care / Healthcare Agent or Proxy

When a doctor or advance practice practitioner (APP) determines you do not have the capacity to make your own decisions, because of medications, advanced illness, or other conditions like Alzheimer’s/Dementia, they will consult your Durable Medical Power of Attorney for Health Care (an advance directive) to determine the people you have chosen to speak for you in these situations.

It is recommended that you pick at least two people – a primary and then a first alternate in case your primary is not available.  You may prefer selecting a third person as a back-up.

Also known as a health care agent, this person needs to be willing to serve in this important role, and fully support your wishes even if they do not agree with them. Having a Medical Power of Attorney ensures there is no guessing or incorrect assumptions about what you want should you not be able to speak for yourself.


The third legal document you need in the last year of life, when you are transported between home and treatment facilities like a hospital or rehabilitation center, is a Physician Order for Life Sustaining Treatment.

In Pennsylvania, that is a POLST (Pennsylvania Physician Order for Life Sustaining Treatment), and in Maryland, it is a MOLST (Maryland Order for Life Sustaining Treatment) document.

Emergency medical technicians cannot honor your living will. They can only honor these documents that outline a physician order for care.  It can include a “Do Not Resuscitate (DNR) order”, or an order for comfort care only without further hospitalizations. Note: a POLST or MOLST are not substitutes for an Advance Directive.

Once you have a completed the POLST/MOLST form, put it on your refrigerator or hang it close to your front door. EMT’s are trained to look for the document in these places.  In PA, the POLST is on pulsar pink cardboard stock paper and is hard to miss.

Additional information about Advance Directives and POLST/MOLST

You can change your Advance Directive at any time. Each new document cancels the previous one.

Note: Different states use different versions of an Advance Directive; use the version for the state in which you live. Your document that is legal where you reside must be honored wherever you are being treated (for instance on vacation in another state).

To obtain a copy of the Advance Directives and POLST/MOLST forms, contact your doctor’s office, the local hospital, or any health system website.

The POLST/MOLST forms must be completed and signed by a physician or nurse practitioner.  The Advance Directives can be completed by you and then signed and dated in front of two witnesses who are not your Durable Power of Attorneys.  You do not need an attorney or a notary for documents in Maryland or Pennsylvania.

Once you have completed them, make sure to have your doctor or hospital scan them into your electronic health record, share a copy with all of your Durable Power of Attorneys, and family members or loved ones who will help to support your care. Put a copy in your car and a copy in your suitcase for when you travel.  Do not put this document in a safe or safety deposit box as it makes it too hard to obtain during a crisis.  Taking these steps ensures your documents are  easily available to those who will care for you.

Still Have Questions?  

Here are additional resources to help you:

  1. York County Your Life, Your Wishes  or call 717-793-2113
  2. York County Bar Association Estate Planning Council
  3. WellSpan Health Horizon Planning Service or call 717-812-6065
  4. UPMC Advance Care Planning
  5. Penn Medicine Advance Directive
  6. Penn State Health


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