Physician Orders for Life-Sustaining Treatment ~ POLST
Today we’re going to be talking about a document for estate planning called a Physician’s Order for Life Sustaining Treatment abbreviated “POLST”.
It’s a document as part of a comprehensive estate plan and it’s a voluntary form. It has to do with a person’s interaction between them and their medical doctors. The form POLST is authorized under California State Statute and other states have similar statutes, it’s voluntary no one has to fill it out under any circumstances and it’s designed for people who are seriously ill perhaps in their last year of life. It specifies what kinds of treatment they would like to have and not have.
The physician’s order for life-sustaining treatment does not replace a more common form called an Advanced Health Care directive where you appoint an agent to work with your medical providers should you not want to work with them or if you’re unable to work with them.
For example the POLST form does not replace the Advanced Health Care Directive (AHCD) the POLST form should be completed by your doctor or another trained medical person. A doctor, nurse practitioner, or nurse’s assistant must sign this form in order for it to be valid. Evidently the state of California thought that people were so stupid they couldn’t even sign their own form deciding on what kind of Health Care they wanted. They had to have doctor supervision. Talk to your doctor if you have questions as they will be able to explain different things. It’s not valid until you sign it and the doctor, nurse practitioner or physician’s assistant signs it and once it’s completed a copy will go into your medical record and you should keep your original on bright pink paper. It’s done so that it distinguishes it from other types of documents for emergency medical rescue, fire, police, ambulance, or other teams that are helping you.
It should be revised every so often every few years to see if your wishes have changed and you might find that you know when it comes closer to your last days in life that you might want to change things around.
Additionally if you decide to change your mind and void your POLST document or change it the recommended procedure is you take a big marker and right across it big lines across and right void and the date that you voided the document. Then you create a new Physician’s Order for Life-Sustaining Treatment. Have your doctors or doctor Personnel sign and you sign it again as the revised version of the pulsed form. That way it doesn’t confuse people. In addition, if you are to change or void your POLST everybody who was given a copy originally should be given the revised copy and the notice that the prior one had been voided.
This form is available online. There’s a group called ‘The Coalition for Compassionate Care’ in California and they make this form available. There are other websites where you can find the form. It was created by a combination of Emergency Medical Service Authority for California and it’s accepted now in all medical contexts for transactions or people that are California residents.
You need to think through and be clear on the wording because some wording becomes ambiguous like CPR because there’s more than one type and you need to be extremely specific in creating this type of document. On ‘Item A’ on the form it asks about cardiopulmonary resuscitation so if the patient has no pulse and they’re not breathing should rescue personnel attempt CPR? If you say yes then that’s the full treatment, it’s not just pumping on your chest and blowing air in your lungs, it also includes the paddles of life, electoral shock and other types of resuscitation. If you don’t want that service then do not attempt to resuscitate to allow natural death.
One thing that people are usually unaware of is CPR breaks bones. Most people who get CPR end up with broken ribs and despite how it looks in the movies where everybody gets CPR and then they jump up and they go shopping in reality only about less than 10 percent of the people who are administered CPR live so it’s not the end-all be-all.
Part B on the form talks about other medical interventions such as if the patients are found without a pulse and not breathing. The first choice is full treatment, prolonging life by any means possible including heroic means if necessary. If that’s the case, there’s also a choice if you want a trial period for example, do everything you can to keep me alive for three weeks and after that time stop the full treatment. Another choice in Part B is selective treatment with the goal of treating the medical conditions while avoiding burdensome measures with care. There’s a couple of different kinds of care but one is to mitigate the symptoms like pain and then other types of treatment are to help the cause of the problem. It’s not all the same terminology when you’re filling out the forms and when it says selective treatment you’re looking also for comfort focused treatment such as antibiotics or fluids.
If you say Do Not Intubate that means anything related to airway passages. Could be a tracheotomy or other types of breathing apparatus that may keep the airways open. You can request that you only have this type of care if you have to be transferred to a hospital but if you do not have to be transferred to a hospital then you can stay at your current location for example dying a natural death at home.
There are other kinds of comfort-based treatment like morphine, use of oxygen, suction of airways and other types of things. Hospice probably should be involved at that point. There’s a misconception with hospice that when someone’s in their last few days of life that hospice is always there but that’s not the case. I think most often hospice is called in too late because the average time period with hospice care is less than 48 hours and the death and dying process sometimes can take quite a bit longer than that. With hospice care the goal is comfort based treatment, not so much trying to fix the underlying medical problems.
Section C on the form deals with whether you want artificially administered nutrition either orally or interveniously. Either, yes or no, or for a certain period of time you have that choice and then the doctor has to put that he or she discussed the Advanced Health Care directive with you.
If you have an Advanced Healthcare Directive they want it attached and close by and then the doctor, nurse practitioner or physician’s assistant (all of which have state licenses) can sign the form to make it legally valid. If it’s not signed by your doctor it’s void.
In the last part of the form you have a section where they finally ask the decision maker what they really want and they sign off at the bottom of the form. There’s a lot of details going on in creating a Physician’s Order for Life-Sustaining Treatment. It does not replace an Advanced Healthcare Directive and it does not replace a do not resuscitate order.
If you have any questions on this subject you can contact REX CRANDELL FIRM in Walnut Creek at 925-510-0929 and we’ll be happy to help!
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