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On the Edge of Death—To Intervene or Not: Advance Directives 

On the Edge of Death—To Intervene or Not: Advance Directives
Chapter:
On the Edge of Death—To Intervene or Not: Advance Directives
Source:
Legal and Ethical Issues in Emergency Medicine
Author(s):

Alexander Zoretich

and Arvind Venkat

DOI:
10.1093/med/9780190066420.003.0005

Advance directives and actionable medical orders are documents that convey a patient’s wishes regarding medical treatment. Common advance directives are living will and health care power-of-attorney documents. Living wills state what a patient wants if not able to communicate for themselves and having an end-stage medical condition or permanent unconsciousness. Health care powers of attorney state whom a patient would want to make medical decisions on their behalf if not able to communicate for themselves. Both of these documents have minimal application in the emergency department given the time constraints of care in this setting. Actionable medical orders, such as Physician Orders for Life-Sustaining Treatment (POLSTs), have immediate application in the emergency department but carry their own challenges in interpretation by emergency physicians. This chapter reviews the nature of advance directives and actionable medical orders and the legal and ethical challenges posed by their application in the emergency department.

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