Paula Span wrote a very important story on the New York Times‘ New Old Age blog about how – despite the best efforts – a dying person’s documented wishes might be unknown or ignored.
The story discusses one possible solution – the use of a POLST form. POLST stands for a Physician Orders for Life Sustaining Treatment. The story explains:
“Oregon, which pioneered POLST (Physician Orders for Life Sustaining Treatment) 20 years ago, in 2009 created an electronic Polst registry giving emergency workers and hospitals round-the-clock online access.
In a new study of 58,000 Oregonians who died in 2010 and 2011, the registry’s first two years, (researchers) found that with Polst “you are extremely likely to have your wishes respected,” she said. Of those who specified “comfort measures only,” only 6.4 percent died in a hospital. Because some terminally ill patients can’t be kept comfortable at home, that percentage will never be zero. Those who specified “full treatment” to prolong life, on the other hand, were more apt to die in the hospital (44.2 percent) than those with no Polst in the registry.
Alas, most of us don’t live in Oregon (or West Virginia, which also has a state registry). Although more than 40 other states have some sort of Polst program, they’re not nearly as advanced and may not extend to every region or hospital or ambulance squad.”
My 93.5 year old Dad lives in an assisted living facility and he has a POLST form. But after reading the NYT story, I did some digging and soon learned that his state does not have an electronic POLST registry.
So reporter Span’s advice stands:
“Meanwhile, the best advice I can find is that everyone should have an advance directive, discuss his or her decisions with doctors and family members, and appoint a strong health care proxy. Then that person has to physically shove the appropriate forms under people’s noses at every hospitalization, every visit to a new physician, every transfer to a nursing facility. … Even then, things can go wrong.”
I don’t have much confidence that my Dad’s POLST will be known or followed if he has a cardiac arrest or some other event in a public hallway or dining room of the facility in which he lives. There appear to be a lot of holes in the non-system.
———————
Follow us on Twitter:
https://twitter.com/garyschwitzer
https://twitter.com/healthnewsrevu
and on Facebook.
Comments (3)
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Maggie Mahar
June 30, 2014 at 2:19 pmA DNR anklet is good—but it don’t help you if you don’t need to be resuscitated.
You also need protection against being kept alive through extraordinary measures,
One of the easiest (and least panful) ways to die to stop fluids and food (this needs to be
supervised by a palliative care specialist or hospice worker who will oversee your care, control
pain, etc.)
But many hospitals won’t do this—even if you have an advance directive and a strong health care proxy–unless you are in the hospital’s hospice care unit (NOT its intensive care unit.)
Alternatively , if the doctor says the patient is within 6 months of dying he or she can be transferred to a hospice. Medicare will pay for it, and hospice workers will withhold food and liquids.
The main thing to remember is this: if you want to be sure your advance directive is honored, don’t go to an ER or a hospital. If you are that sick they are likely to put you in an ICU–a very difficult way to die.
Stay at home or in your assisted living facility.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like