25 Nov Ask Alice November 2020

We answer your questions about Advance Care Planning

Dear Alice,
When folks talk about advance care planning, they often use different terms that seem to be the same thing. What is the difference between an Advance Directive, a Living Will, and an Appointment of Health Care Agent or Proxy?
Please help me out with a little clarification. I can’t imagine I’m the only one wondering.
Thanks, Terminology Challenged


Dear Terminology Challenged,
Like just about any area of human activity, advance care planning has its own terms of art, and those who use them regularly often forget that others may not understand what they are talking about.
I can clarify these terms for you fairly easily, though, and maybe throw in a little historical background along the way. Back in the 1970s, there was already recognition that patients could not be treated without their consent; yet there was no established procedure for what to do when patients were no longer capable of deciding whether to consent or not. At the same time, medical technology was advancing to the point that more and more patients could be kept alive even though recovery was unlikely; so more and more tough decisions needed to be made.
In this context, attorneys began experimenting with documents in which individuals could indicate ahead of time, in writing, the extent to which they would consent to life-sustaining treatment. These documents came to be called Living Wills, and many of them are still in use today. But the usefulness of Living Wills was limited by the narrow range of healthcare decisions they could specifically address; so they were gradually supplemented by other documents in which individuals could choose who would make healthcare decisions for them should they become unable to make them for themselves. And these documents we now call Appointment of Health Care Agent or Proxy (or something similar).
Today in Vermont we use a single document that includes both the substance of a Living Will and the substance of an Appointment of Health Care Agent or Proxy, and we call it an Advance Directive. This makes the process more efficient and straightforward, and makes it easier for more people to have an Advance Directive and be able to say “yes” when their health care provider asks them if they have one.
Adding to this confusion of terms, each state in the US has adopted its own laws about advance care planning and each use these different terms to define requirements of that state’s laws; for example, an agent in Vermont is a healthcare proxy in Massachusetts. This is why it is very important if you move to a new state to make sure you have a new Advance Directive/Living Will for that state.
One other term that may confuse you is the term for a clinician/physician/medical order of life-sustaining treatment. In Vermont we have a COLST, while in other states you would have a POLST or a MOLST. I’ll write more about what a COLST is in a later issue.
This probably gives you way more information than you wanted. But in summary, a Living Will addresses an individual’s general wishes with respect to medical care, an Appointment of Health Care Agent or Proxy addresses who will speak for an individual if they are unable to speak for themselves, and an Advance Directive is a single document that encompasses both.
Hope this helps.
Best wishes, Alice

As always, please contact Don Freeman, Taking Steps Brattleboro Coordinator, 802-257-0775, ext. 101, or don.freeman@brattleborohospice.org, for information about Advance Care Planning.
Till next month, folks. Please send your questions to Alice via info@brattleborohospice.org.