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Advance Directives
202 EAST 10TH ST. ERIE, PA 16503
Living Will – A written statement of your personal desires
regarding life-sustaining treatment and other care.
POLST (physician’s order for life sustaining treatment).
Similar to a L.W. but done with your Doctor and it is viewed
as a physician order for healthcare professionals to follow.
A health care agent is a person you choose in advance to make
health care decisions for you in the event that you become
unable to do so. A health care agent can help make medical
decisions on your behalf at the end of life or any other time
you are not able to communicate, such as if you are severely
injured in an accident. A health care agent also may be called
a health care proxy or surrogate or an attorney-in-fact.
Healthcare Representative – The health care representative in
most cases will be selected by the statute, not by the patient
himself or herself.
Healthcare providers, physicians or there staff may not sign for
a patient they are treating.
H.C. providers may assume that an AD presented to them is
Executing an advance directive
Adults (18 and over) of sound mind
An advance directive must be in writing, dated and signed by
the patient or an individual acting on the patients’ direction.
Witnessed by 2 individuals who are 18 or over
Advance directives are only enacted when:
A Physician has documented:
 a) You are incompetent
b) You are permanently unconscious
c) You have a life limiting diagnosis or are
at the end stage of a medical condition
Incompetent: Generally means that the patient is not able to
understand, make and communicate health care decisions, even
when provided appropriate information and aids.
Permanently Unconscious: A medical condition in which the
patient has total and irreversible loss of consciousness &
capacity for interaction with the environment, such as
irreversible vegetative state or an irreversible coma.
End stage medical condition: An incurable & irreversible
medical condition in an advanced state caused by injury,
disease, or physical illness that will result in death despite the
introduction or continuation of medical treatment. Note: there
is no maximum life expectancy parameter. The condition needs
to be advanced.
Living Wills focus on life-sustaining treatment & other end of
life care.
A health care agent may be given authority as broad as the
patient would have if competent.
In contrast to living wills, health care agents are not restricted
to end of life decision making
A health care agent when duly authorized generally may direct
the provision, continuation, withholding, or withdrawal of all
forms of medical care from the patient.
Unless a patient designates a HCPOA the following is the
statutory order accordingly:
1) Spouse
2) Adult child
3) Parent
4) Adult grandchild
5) Close friend
As is the case of a health care agent, a health care
representative generally may direct the provision, continuation,
withholding or withdrawal of medical care including life
sustaining medical care.
Living Wills are not required to be notarized in Pennsylvania if
you travel amongst other states please verify each states law
regarding living wills.
Emergency professionals may disregard living wills, if you
have a signed and completed POLST form (on the proper pink
paper) your wishes may be honored.
Modified rules apply to withholding or withdrawal of artificial
nutrition & hydration. There is a “rebuttal presumption” that
the patient would want this treatment in the absence of the
patient specifically stating otherwise in writing. Generally,
speaking, the presumption may be overcome if the patient
clearly expressed wishes to the contrary or it is clear from the
patients’ preferences & values that the patient would not want
the artificial nutrition & hydration.
A direction to withhold or withdraw life sustaining treatment
generally does not prohibit the provision of comfort care or
other beneficial care.
Special restrictions apply to withholding or withdrawing lifesustaining treatment from pregnant women.
Prescribed decision making process for health care agents &
representatives includes requirements to protect against
discrimination of patients because of a disability.
If providers refuse to follow the withdrawal of
nutrition/hydration then the patient can/may be transferred to
another facility
Hospice Care
Hospice Care
•Specialized care focusing on improving ones quality of life.
By providing relief from symptoms, pain and stress of serious
•Palliative care is for people with serious illness and/or chronic
•Services provided by doctors, nurses, and other healthcare
Diseases (not all inclusive)
Congestive Heart Failure
Chronic heart disease
Kidney failure
Alzheimer’s (late stage)
And many more (discuss your chronic condition with your
Controllable symptoms
Shortness of breath,
Nausea or loss of appetite
Constipation or diarrhea
Difficulty sleeping
Symptoms affecting your quality of life
Additional benefits of hospice care
Close communication with your healthcare team
Expert management for symptoms
Help navigating the healthcare system
Guidance with difficult & complex treatment options
Emotional & spiritual support for you and your family
Life expectancy of 6
months or less
Care is provided when
treatment options are
Care is provided in the
patients home (private
residence, nursing
home, assisted living
Paid by Medicare,
Medicaid, private
Assists with paying for
equipment and other
services necessary for
the comfort of the
patient and
management of the
terminal disease.
No homebound
Starts at time of
Can be provided in
conjunction with
curative treatments
Most often provided
in the hospital but is
starting to be
accessible in the
Limited funding
sources for this care
No reimbursement
for additional
 (814) 456 6689
Hospice of
Metropolitan Erie
202 East 10th St.
Erie, PA 16503