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An electronic registry to convey end-of-life wishes

The Kaiser Family Foundation has estimated that approximately 60 percent of adults over 65 have advance medical directives. While it is a good idea for all adults to have these documents, what happens if they cannot be accessed quickly? A California pilot project is a step in the right direction to ensuring emergency responders and hospitals can immediately review end-of-life wishes.

In Colorado, advance medical directives include two important documents - a Living Will and/or Medical Durable Power of Attorney. These allow you to appoint a trusted loved one to make medical decisions on your behalf. You may also include wishes about end-of-life "quality of life" preferences. To honor your wishes, doctors and nurses need to know they exist and where to find them.

From card in the wallet to digital database

Medicare currently recommends keeping originals of advance directives in an easy to find place. The agency also suggests that you provide family, health care providers and a nursing home with a copy. The last piece of advice they offer is to carry a card in your wallet explaining you have advance directives in place.

The problem with all of these is that they take time. The card in your wallet says you have advanced medical directives, but it doesn't detail what they are.

As medical records have gone digital, these advance directives can still get lost. Here are just a couple examples of what can go wrong:

  • Your primary care doctor may use a different software system that doesn't easily communicate with the hospital
  • Medical records systems may not have a dedicated tab to easily convey the information

When these advance medical directives cannot be located quickly, the most treatment available is usually provided. This may be unwanted.

A California pilot program

The Physician Orders for Life-Sustaining Treatment (POLST) conveys California patient choices about medical care in an emergency. In several counties in the state, emergency and social service providers are working together to create an electronic registry of these forms. This will make the forms available to first responders and medical providers when needed. Electronic registries already exist in a handful of states including Oregon, New York and West Virginia.

Colorado has forms that serve similar purposes that include a:

However, after passage of Prop 106 it is important to note that a MOST form cannot be used to request a lethal prescription. But if a loved one has sought relief under the End-of-Life Options Act, it is recommended to have a CPR directive and MOST form in case it is requested by emergency or hospice personnel.

These forms work in coordination with advance medical directives. The Living Will and Medical Durable Power of Attorney are more comprehensive, because they allow you to name an agent to make medical decisions on your behalf.

Because it might some time until Colorado has an electronic registry, it is important to tell family or care providers that you have completed these documents. An attorney can help you develop a tailored strategy to ensure that the right people have access to your advance medical directives when needed.

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