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Why the POLST is better than sliced bread and why we are inhumane if we do not adopt it.

Monday, 26 Mar 2012 10:39

About Dr. Monica Williams-Murphy (120 Posts)

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page


First, what the heck is a POLST anyway? “POLST” is an acronym for “Physician Orders for Life-Sustaining Treatment”. This is a paradigm shifting legal document that may be adopted on a state-by-state basis and which is transforming end-of-life care. How? By taking information only formerly found in your living will and putting it into a legal medical document, which is signed by your physician—this order will be “obeyed” in any medical scenario in which you find yourself.

To make it very clear how important this tool is, let me tell you about a family who could have really appreciated a POLST, but whose state had not yet adopted one:

Patient  M.C.

M.C. was brought into the Emergency Department by a loving daughter, and appeared to be dying according to the wise evaluation by the Emergency Doctor caring for M.C. This doctor could see that M.C. would be best served by hospice at that time rather than a hospitalization for an attempt at curing that would prove futile and would only increase or prolong suffering for M.C.

After discussing this perspective with the daughter, she agreed that the best interest of her beloved parent at this time would be to focus on comfort providing medicine and to allow M.C. to die a natural, peaceful death back at the assisted care facility. After this discussion, the daughter actually felt affirmed that she had chosen an honorable death for her parent, a choice filled with dignity and compassion. She felt at peace as they returned to the assisted facility with plans to be admitted to hospice the next morning. The kind and wise Emergency Doctor had personally arranged for hospice and had written a Do Not Resuscitate (DNR) order on a hospital order sheet and signed it.

Imagine her horror as she entered her parent’s room the next morning to find the staff doing chest compressions on her dear parent!

“Please stop!” she cried out.

“This is not what (M.C) wanted and not what we wanted! The doctor from the ER even signed DNR paperwork last night!”

The staff responded that because M.C. did not have signed DNR paperwork specific to their institution, they were required to do CPR…

Desperate, she pleaded, “Please call our doctor and see if he can have this madness stopped!”

**************

If your blood is boiling over, welcome to the club. I see and hear about this type of insanity all the time, usually in the following types of cases:

Either:

1- End-of-life care wishes (which may exist in a living will in the third drawer of a desk at home) are not written on state approved documents and therefore, are NOT honored,

OR

2- These wishes (such as DNR) are recorded on documents that are official in one facility (such as a hospital), but those documents are not transferable to other places (including home or an assisted facility). So, one might have elected to have DNR orders while hospitalized, but if these orders are not transferred to state approved DNR forms (if you are going home) or institution-specific forms (if you are going back to an assisted facility), then you will not be allowed to have a natural death…you will be “coded” and brought back to the hospital to be put on artificial life support should you “survive.”

Now to relieve your angst (and mine), I will tell you that the POLST solves all of these problems.

1st- Your end-of-life wishes will become ACTUAL MEDICAL ORDERS with your physician’s signature.  The POLST will tell other doctors and medical personnel whether or not you want CPR, what types of medical interventions you want or don’t want– including your choices regarding artificial nutrition, or even antibiotics.

2nd- Your official wishes documented in your POLST will be in effect wherever you are: home, gas station, assisted living facility, movie, hospital, “Dairy Queen”, or nursing home (as long as the form is with you, prominently posted in your home, or on file in your medical facility). The POLST is “portable” and is “obeyed” by all medical personnel regardless of place or circumstance.

Therefore, if you are in a state which has already adopted the POLST, consider yourself fortunate, thank those who lobbied for it, and get your own POLST signed by your doctor, clearly enforcing your wishes.

If you are in a state which has NOT yet adopted the POLST, get to work getting it passed…so you or your loved one will not end up like M.C.

See POLST.org for more!

Monica Williams-Murphy, MD

(The story of M.C. is a composite of 3 different cases of which I am aware.)

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