An Advance Directive is a set of instructions, usually written, that allows you to specify the kind of treatment you would want if you are ill and unable to speak for yourself. The Living Will and the Durable Healthcare Power of Attorney are advance directives and we suggest you have both. With an advance directive, you can inform your doctor what your wishes are. You may change your advance directives at any time. Only you can change your advance directive. Each state has its own laws about advance directives and you should be aware of the laws in your state. Generally you can prepare advance directives in several ways:
- Use computer software for legal documents
- Download forms from web sites (Hawaii Advanced Health Care Directive Form)
- Write your wishes clearly on paper
- Obtain forms from the local health department or state department on aging
- Utilize an attorney
Durable Healthcare Power of Attorney
A Durable Healthcare Power of Attorney is an advance directive that allows you to name an agent to speak for you in medical matters if you cannot speak for yourself either because of illness or an accident. Your agent should know your wishes and agree to follow them.
A Living Will is an advance directive that states your wishes for medical treatment, including artificial nutrition and hydration, when you are in imminent danger of dying.
Five Wishes – a form of a Living Will
Five Wishes is the first form of a living will that takes into consideration your personal, emotional and spiritual needs. It is an easy-to-complete form that lets you say exactly what you want. Once it is filled out and properly signed it is valid under the laws of most states. There are many things in life that are out of our hands. The
five wishes document gives you a way to control something very important – how you are treated when you are
seriously ill. For a link to the Five Wishes document see the bottom of this page.
Community Resources for Older Adults
You will find links below to the Aging and Disability Resource Center, a one-stop source for information, assistance,
and access to community resources and services for older adults, people with disabilities and family caregivers. The
Aging and Disability Resource Center serves as a virtual Aging and Disability Resource Center that, combined with
traditional face-to-face services, provides greater options for accessing information, assistance, and referral for
families living either near and far.
For more information you may also contact the Maui County Office on Aging Main
Telephone: (808) 270-7774
at 2200 Main Street, Suite 547, Wailuku, HI 96793
www.hawaii.adrc.org or www.mauicountyadrc.org
Do Not Resuscitate Order (DNR)
Some people who suffer from pain or have a terminal illness would rather not be resuscitated. To allow people to refuse
resuscitation, the “comfort care only” law was created in 1994. It provides a way for others to know quickly if a
person does not want to be resuscitated when his breathing or heart stops. A Do Not Resuscitate (DNR) Order is
another kind of advance directive. A “Comfort Care Only - DNR” order is the legal declaration of a terminally ill
patient’s order to all emergency medical services personnel, first responder personnel, and health care providers
to provide the patient with comfort care measures only and to NOT attempt to resuscitate the patient should the
patient’s heart or breathing stop. Comfort care measures include pain medication, oxygen, suctioning fluid from
a patient’s mouth to prevent choking, splinting fractures, and other measures designed to make the patient more
comfortable. Comfort care measures DO NOT include attempts to resuscitate the patient such as chest compressions,
administering electrical shocks, putting a tube in the throat, and providing artificial breathing for the patient, or trying
to restart the patient’s heart or breathing. DNR is a request not to have cardiopulmonary resuscitation (CPR) if your
heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose
hearts have stopped or who have stopped breathing). You can use an advance directive form or tell your doctor that
you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders
are accepted by doctors and hospitals in all states.
POLST (Physician’s Orders for Life-Sustaining Treatment)
Downloadable Form: Hawaii POLST Form
POLST (Physician’s Orders for Life-Sustaining Treatment) is a physician’s order that gives patients more control over their end-of-life care. It specifies the types of treatments that a patient wishes to receive towards the end of life. Completing a POLST form encourages communication between healthcare providers and patients, enabling patients to make more informed decisions. The POLST form documents those decisions in a clear manner and can be quickly understood by all providers, including first responders and emergency medical services (EMS) personnel. As a result, the patient’s wishes can be honored across all settings of care. The POLST form is usually completed on a distinctive bright lime-green form, but is also freely available from the internet and is acceptable in black and white. The bright color is to make the form quickly visible to families and emergency medical services personnel. The lime-green color is also easily copied. A copy is a valid document.
POLST does not replace an Advance Health Care Directive (AD). The AD can provide a significant amount of more
detail about an individual’s wishes and preferences for treatment. In addition, the AD is the most common mechanism
for designating a surrogate decision maker for the patient. The POLST does not provide for the designation of a
surrogate decision maker.
For the patient at home, the POLST form should be kept in a place readily accessible by family members. Examples
include on the refrigerator, in the medicine cabinet, on the back of a bedroom door or on a bedside table.
Aging a Disabilities Guide 2012
Downloadable Guide: Aging a Disabilities Guide 2012