Fifty years ago, California passed the first legislation authorizing "living wills" with the passage of the "Natural Death Act." Since that time, legislatures in every state have enacted and revised laws pertaining to "Advance Medical Directives." Among clinicians, however, there remains widespread confusion regarding the operative legal effects of these laws. This presentation aims to clarify legal issues pertaining to AMDs and the "POLST Paradigm," with an overall objective of stimulating discussion regarding how these documents impact clinical practices. The underlying thesis is that no legislation regarding AMDs, nor any document executed pursuant to such law, relieves clinicians of their ethical responsibilities to provide care in alignment with the four-fold hierarchy of patient good as expressed in the teachings of Dr. Edmund Pellegrino.
