Medical and legal end of life care talk with your doctor

THE LEGAL FORMS YOU NEED There are two kinds of forms people need to ensure they get the care they desire at the end of life: legal documents and medical orders. Advance directives are legal

documents and include a health care proxy (also called health care or medical power of attorney) and a living will. They spell out what a person wants done if she is unable to speak for

herself, as well as who is delegated to speak for her. In some states the proxy and the living will are part of one document, but it can vary from state to state. State-specific advance

directive forms can be found at www.caringinfo.org. People often hire lawyers to prepare these forms for them, but it's not required. Forms can be downloaded and filled out by

individuals, but must be notarized and witnessed to be valid. You should know that advance directives may not always be followed by medical personnel, especially in an emergency. That's

why you also need a medical order. A medical order, called a POLST (Physician Orders for Life-Sustaining Treatment), makes those advance directives binding on all medical staff, including

those in the emergency room and in the ambulance. The medical order is also what indicates whether a patient has a do-not-resuscitate (DNR) order. Here are more details you should know.

Health care proxy: If you want to make sure you have control over what happens to you medically once you can no longer express your own wishes, the first step is to legally name a proxy or

someone you trust to speak for you if you become unable to speak for yourself. Without a proxy, the default action will be to do everything possible to keep you alive. Before you name that

proxy or surrogate, you need to speak with that person to determine whether he is willing to honor your preferences, even if they differ from his own. Your proxy needs to know, for example,

whether you wish to pursue every possible treatment, no matter the side effects, or whether you only want comfort care. Most people name a family member or members, but others choose a

friend, neighbor or minister. Some parents are hesitant to single out one child as their proxy. It is possible to list a number of proxy decision-makers and to say in your document that all

should be consulted in arriving at the best decision for you. The important factor is to choose the person or persons you trust who will accurately represent you and your preferences, Meier

says. Living will: This is a general guide that explains your values and priorities and spells out the treatments you would want — for example, resuscitation, mechanical ventilators,

dialysis, organ donation, comfort care, doing everything possible to keep you alive. Meier recommends that patients ask their health care provider questions about these or any other specific

treatments "and then weigh whether the risks outweigh the benefits." MEDICAL ORDERS: The Physician Orders for Life-Sustaining Treatments program, cofounded by Susan Tolle, a

physician and director of the Center for Ethics at Oregon Health & Science University, should be considered if you have an advanced chronic disease or are becoming more frail.