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Doctor suggests going one step further than living will

Living wills and medical powers of attorney are among the many useful documents that experienced estate planners in New Jersey regularly employ to be sure that their clients retain the greatest measure of control over the care they receive. Having such a plan in place is good advice for everyone.

Most in the medical profession tend to share the opinion about the positive value such living wills and advanced directives deliver. They're grateful for the guidance they provide about what a person's wishes may be regarding end of life treatment. At the same time, there are some who hold that most living wills are useful in only narrow, emergency or terminal situations. They say that in the face of medical technology that makes it easier than ever artificially sustain life, something more specific is needed.

One solution they offer is called the "Physician Order for Scope of Treatment." First drafted in 1991 in Oregon, it is now accepted under varying names in 13 more states so that patients who are seriously or terminally ill, or suffering advanced frailty, to provide very specific written orders about their preferred treatment choices.

They point to a couple of things about the scope document as being beneficial. Unlike typical living wills, the POST orders build on specific conversations with doctors and other care providers. They reflect not only the patient's current condition and prognosis, but their faith, culture and family values. And, as conditions change, the POST can change, too.

Additionally, supporters say that in states where it's recognized, the document can follow the patient across any health care setting they might be in, whether it's an emergency room, hospital, nursing home, home health care or hospice care.

Legislation calling for creation of a standardized Physician Order for Life Sustaining Treatment form is now on the books in New Jersey. Gov. Christie signed the measure into law in December. Work on the form is said to be under way.

In the meantime, those considering a living will or the more recent document should be in touch with an attorney.

Source: South Bend Tribune, "Enhancing end-of-life care in Indiana," Dr. Richard Feldman, Feb. 27, 2012

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