End-of-Life Choice, Palliative Care and Counseling

Idaho leads at helping people die their own wayby Jay

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By Kathleen Kreller
Daily Camera
June 1, 2012

Several times a week, health care workers show up on Tom Thompson’s doorstep south of Boise.

A nurse and health care worker make sure that Thompson, 82, is taking the right medications and that his breathing isn’t too labored from chronic obstructive pulmonary disease and emphysema.

Thompson won’t recover from his disease, and he’s already made choices about the end of his life: no artificial means.

Being able to leave detailed instructions is possible thanks to a relatively new and sophisticated approach that is making Idaho one of the most advanced states in the nation for helping residents get exactly the care they want at the end of their lives.

Idahoans now have access to a detailed form approved by the state to be filled out with the help of health care professionals. Once signed by a doctor or nurse practitioner, the document is legally binding. Patients can register the document with the secretary of state, making it available online to any provider.

Thompson got assistance with his form from workers at Boise’s Life’s Doors Hospice and Home Health Care.

“I don’t want to be on life-support garbage,” Thompson said. “I don’t want to live longer than my kids. I’ve signed it all.”

When many Idaho residents approach the end, they want to know that their wishes for care — or the lack thereof — are respected and followed.

For a while, that was a problem. As recently as 2002, Idaho received a D-plus grade from the Robert Wood Johnson Foundation when it came to looking after the wishes of elderly and dying patients.

Until 2007, Idaho offered only the form known as Comfort One, a do-not-resuscitate form. Such DNRs, as they are known, inform doctors and nurses when a patient doesn’t want heroic measures to prolong life.

If a patient ended up in an emergency room on oxygen or in dire health and his or her heart stopped, doctors and nurses were not bound by the Comfort One document.

It was certainly good information and revealed some of the patient’s wishes, experts said, but the fact that it wasn’t a binding document was a problem.

“One of the things that everyone shares is the desire to relieve suffering,” said Peter Kozisek, medical director for St. Luke’s Regional Medical Center’s palliative service and a member of the Idaho End-of-Life Coalition. “Our goals are to honor patients’ directive for care.”

In 2002, a coalition of Idaho associations of hospices and palliative care professionals decided to do something about the inadequate protections for the wishes of the sick and the dying.

In partnership with the Idaho secretary of state and other medical groups, the coalition created the Physician Orders for Treatment program, or POST.

Gov. Butch Otter signed the protocol into law in 2007.

The program is designed to help patients get exactly the care they want, said coalition member Rick Bassett.

From that nearly failing grade in 2002, Idaho rebounded to be among the states leading the country in the movement to improve the quality of end-of-life care.

Idaho’s program is patterned on the one in Oregon, which embraced the end-of-life discussion early, said Dr. Theodore Walters, an oncologist medical director at Life’s Doors who has practiced medicine since the 1970s.

The POST is a document that helps health care providers work with their patients to articulate their medical wishes. Once a primary-care provider signs it, the form is a physician’s order that is in effect from emergency rooms to hospices.