What is the difference between a POST and an advance directive?
Advance directives such as Living Wills and Healthcare Powers of Attorney are legal instruments completed by individuals that require witnesses and notarization. The Living Will informs physicians and other healthcare providers regarding the level and type of care desired by the patient in certain end-of-life situations if the patient is no longer capable of making or communicating these decisions. A Healthcare Power of Attorney designates who can make certain decisions on behalf of the patient if the patient is unable to do so. However, to carry out a patient’s wishes regarding the level of care provided, a physician or medical order is needed.
The POST is a medical order issued by a physician that also requires informed consent/agreement of the patient or the legally appointed representative. Unlike an advance directive, a POST is always completed in consultation with a qualified healthcare professional that is able to provide information to the patient or the patient’s representative about the risks, benefits, and other implication of different types and levels of medical treatment.
As in all physician orders, the POST instructs other healthcare providers regarding the type and level of care to be provided. The POST does not require witnesses or notarization. The POST is the first medical order in South Carolina to require a patient or patient representative signature on the form.
The POST is not meant to replace an advance directive; it is another mechanism to ensure that patient wishes for medical treatment at the end of life are known and honored. A POST form may conflict with a previously executed advance directive, and more accurately reflect a patient’s wishes. As an example, Patient A has a Living Will that has been in effect for many years and states that she does not want her life to be prolonged if she has an incurable and irreversible condition. Years later, Patient A develops an incurable and irreversible condition, and based on her current preferences, has a POST form that states she wants antibiotics, artificial nutrition, and hydration. This is contrary to the instructions in her previously executed Living Will. Rather than revoking her Living Will, the conflicting orders on the POST will only suspend those instructions while the POST is in effect. If the POST is revoked, the instructions in the Living Will once again apply.