Table 1.

Types of Advance Care Planning Documents

Name	Alternate name	Purpose	Applicable situation	Items commonly covered	Creating parties	Jurisdiction
Options for a patient or potential patient who possesses decision capacity:
Living Will19	None	States patient’s preferences for either potential future desired treatments or treatments that the patient would wish to be withheld or withdrawn.	Patient in coma or minimally conscious state, etc., where it is felt that he/she will not be able to regain capacity for decision making.	Medical machinery and techniques which may extend life but not necessary cure underlying medical condition: -Cardiopulmonary resuscitation -Mechanical ventilation -Artificial nutrition via enteral or parenteral route -Dialysis -Organ and tissue donation	Patient Lawyer	Different states have different laws; some may not recognize document if prepared in another state.
Healthcare Power of Attorney20,21	-Health Care Proxy -Health Care Surrogate -Durable Medical Power of Attorney	Designates a person to give him or her broad authority to make health care decisions for a potential patient.	Patient is unable to make or communicate a choice about a particular health care decision, in the opinion of an attending physician.	-Decisions regarding resuscitation, treatments, procedures, tests, and medications -Access to medical records and information -Authorization for admission or discharge, including discharge against medical advice from facilities -Ability to contract for health care-related service and “hire or fire” medical and support personnel -Organ and tissue donation, including autopsy.	Patient Lawyer may assist in drafting, but many states have template forms to complete that only require witnesses	Indiana, New Hampshire, Ohio, Texas, and Wisconsin have requirement for specific forms. California, Connecticut, Delaware, New York, and Vermont have special requirement for who can serve as witnesses as well as for residents of nursing facilities. Some states may limit the authority of a designated surrogate.
Physician Orders for Life-Sustaining Treatment22,23,24	-POLST -In certain states, programs vary by name ie MOLST, COLST, OMST, POST	Serves as a standing medical order indicating a patient’s wishes regarding specific current treatments (e.g, DNR); follows patient across health care settings. Not otherwise intended to replace other advance directives such as a healthcare power of attorney.	Immediately upon signing by physician or other healthcare provider. Generally intended for patients with serious medical illness at the end of life.	-Do not resuscitate order -Do not intubate order -Acceptability of artificial nutrition, including duration.	Patient or patient’s surrogate decision maker Physician or other healthcare provider	Only Alaska, Alabama, Arkansas, Mississippi, Nebraska, and South Dakota do not currently have programs in effect or under development.
In the event a patient becomes incapacitated without advance care planning documentation:
Legal guardian25	Conservator	Appointed by court to give an individual or organization legal authority and duty to care for another person, which may or may not include financial affairs.*	Immediately after court appoints individual or organization.	Appointed party is generally responsible for the daily care, maintenance, and support of the ward and must provide, or contract to provide for, the ward’s housing, meals, administration of medication, and health care.	Court-appointed; may be court-selected if no next of kin is available	State by state, with different regulations. For example, Massachusetts legally requires even next-of-kin to become official court-appointed legal guardian, in absence of previous DPOA.

^*Various terms are used across the country to describe types of guardianship, as guardianship proceedings are a matter of state law, and terminology and procedures differ between states. Some states use the term “guardian” to describe an individual with the legal authority and duty to care for another's person (“guardian of person”) and use the term “conservator” to describe an individual who has the legal authority and duty to manage another's financial affairs (“guardian of estate”).²⁵