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Oregon recently launched a state registry for patients who sign a form known as POLST (Physician Order for Life-Sustaining Treatment). This transferable order set allows patients to give specific instructions on the treatments they would or would not want in certain situations. For example, a patient may opt for or against resuscitation for cardiac arrest, for or against IV antibiotics, or whether or not to place a feeding tube in different scenarios. The POLST orders go beyond most states' DNR (do not resuscitate) orders, which only apply in the event of cardiac arrest. POLST allows a patients to direct their care even when they have become to ill to express their wishes.
One of the biggest problems with advance directives is that emergency crews or hospital staff cannot locate the documents in a crisis, the time when the expressed wishes are most crucial. Unless medical personnel have a verbal or written directive from the patient, we are obligated to perform certain procedures like intubation and mechanical ventilation, which many terminally ill patients do not want. POLST tries to ensure that wishes are honored, but even in states where POLST has been implemented, relying on a paper form has its risks. This program in Oregon would allow medical personnel with a password to instantly access the POLST record electronically, even if the paper document cannot be found. Many times I have encountered situations when a patient was in a crisis, unable to speak, and we could not locate the advance directive or power of attorney. Too often the patient had something done that went against his or her expressed wishes, simply because those expressions were not available when needed.
I understand concerns that people may have about an electronic record of private and personally held wishes that can be used to direct medical care. I believe that this system would give more control to patients, not less. If you take the time to document your wishes, shouldn't they be available to health care personnel in a time of crisis? The registry is purely voluntary; Oregon residents are not required to participate. There is no coersion to choose one option over another; patients may direct care however they see fit, even to request all available treatments or procedures be given under any circumstance. While I do not agree with Oregon's policy on legalized physician-assisted suicide, I believe that a voluntary electronic registry of patient wishes is a helpful addition to the health care system, and I hope that more states adopt such a program.Read more
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I have blogged before about the importance of sharing your end-of-life wishes with someone you trust. Thanksgiving is the perfect time to have that conversation as you gather with family. The fine folks at Engage with Grace have put together a slide of 5 questions that will make this process easier.
If you have the gizzards to bring up these questions at the Thanksgiving dinner table, you deserve the Myles Standish Award for Bravery. Even so, I find that once the ice is broken, these conversations can be quite cathartic, and you and your family will feel like you accomplished something important at Thanksgiving besides overloading on poultry and dozing off into a tryptophan-induced haze. So, after you engage with gravy, Engage with Grace this holiday. You can thank me later.
...would love to hear your comments on how it goes...Read more
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