by Terri Schmidt
Milwaukee Journal Sentinel
October 23, 2012
In 2001, my frail 94-year-old grandmother – a lifelong Wisconsinite – died in a way consistent with her wishes. But it wasn’t easy. It required relentless advocacy by her daughter, who signed “Do Not Resuscitate” paperwork three separate times in one week after my grandmother fell and was taken to the hospital with a serious brain injury.
My grandmother’s loving Brookfield foster home wanted her back with hospice care. Her daughter needed to sign paperwork to confirm her desire to avoid hospitalization and die at home – first at the hospital, then just for the ambulance ride home and again for the hospice admission.
All of this could have been avoided if a system had been in place that made it possible for health professionals to follow a seriously ill patient’s wishes when transferred from one facility to another. With a system in place, patients with advanced illness might have thoughtful conversations with doctors and family about treatments they do or do not want, complete advance directives and appoint trusted loved ones as their health care decision-makers when they cannot speak for themselves.
Despite all this preparation, patient wishes about treatment often are not followed in a time of crisis. Families are often haunted by the belief that they let their loved ones down. They might have promised Mom, who was battling advanced cancer, that they would respect her wish not to be placed on a breathing machine, but when EMS is called, she is placed on a breathing machine and dies in the intensive care unit.
Following years of painful family episodes, local health leaders in La Crosse County found a possible solution: The Physicians Orders for Life Sustaining Treatment (POLST) program. The program provides a forum for families to launch discussions with seriously ill loved ones. It allows patients to talk openly about concerning treatments such as whether they would want chest compressions (CPR) if their heart stops – decisions that should be made in advance of a crisis. Then their physician may create medical orders based on these discussions.
Most important, POLST orders can be used by EMS and emergency departments, and the form travels with the patient from home, to a nursing home or to a hospital, avoiding the need to complete new paperwork every time a person moves.
In the Oct. 17 Journal Sentinel article “End-of-life medical care initiative prompts worries about abuse,” I learned of concerns about the POLST program raised by Wisconsin Catholic bishops and others. The program is used successfully in many other states. Questions such as those posed in Wisconsin arise from time to time; however, our experience is that once POLST leaders have a chance to communicate about the program and answer questions, these concerns are relieved.
I encourage religious leaders and Wisconsin POLST leaders to work together in creating a program in which adjustments that reflect regional beliefs can be made. I believe that a POLST program can be developed throughout Wisconsin that respects Catholic beliefs.
One of the common misunderstandings surrounds who should have a POLST form. POLST was specifically designed for people facing advanced illness. Unlike advance directives, POLST wasn’t created for healthy people who wish to state their preferences if a health tragedy occurs in the future. POLST was created for people in the final months of life. It is for people actively battling serious disease or frailty.
Second, POLST is not designed to cause or hasten death. POLST can be used to request all interventions or only certain ones. It’s designed to record and give patients a voice in their care near death.
Third, POLST has nothing to do with managing costs. It’s about improving communication and planning. The debate over whether programs like POLST save money is irrelevant because in the end, the program centers on the patient’s wishes.
POLST was created with a respect for life and to honor patients’ wishes by facilitating communication about their care if they are unable to communicate. In short, POLST allows patients – who are unable to speak for themselves – to have their wishes honored as they choose, entirely in accord with their religious beliefs.