If you are a planner you should know about POLST

How you want to live and how you want to die. You choose.

Greet the Elephant in the Room

Sorry to be so grim, but the elephant in the room is often present when we talk about death and dying.  We may have our legal advanced directive that spells out our wishes, but do we have a document from our physician that specifically outlines the orders

What is a POLST

A Physician Orders for Life-Sustaining Treatment or POLST is a medical form that should be used for someone, a patient considered at risk for a life-threatening event  (such as cardiac arrest) due to a serious life-limiting medical condition. This may include advanced frailty.

The POLST is not about how you want to die, it is about how you want to live with the time you have left.

A person who is seriously ill or extremely frail should have the choice about the level of treatment they receive. The POLST form is a way for that person to say “Yes, I want CPR and full treatment” or “No, I want to stay where I am and have just comfort care and allowed to be pain free.”  It can range from either spectrum.

It is up to the patient what they want their POLST form to say and it is imperative that the healthcare provider writes it down for others to follow.

A few considerations

  1. The POLST form can be changed or voided at anytime to take into account the person’s wishes.
  2. The POLST form can vary from state to state. See polst.org
  3. The POLST is designed to provide and communicate specific medical orders.
  4. A POLST can be kept nearby if the person is still living at home and can be used by first responders if they are called to the house.

A POLST form does not replace an advance directive (a legal document), yet they work together when needed.

All adults should have an advance directive, however not all need to have a POLST. Be aware, without clear wishes written down, or someone that can serve as your proxy, the healthcare team is obligated to provide full measures to preserve life.

Advanced Directives (AD) and POLST can work together

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from https://polst.org/

Why a POLST?

A POLST was created to help people who have a medical condition severe enough that there is an expectation that an emergency will occur at some point. These people, as their illness or frailty progresses may not be able to have a specific conversation with their healthcare provider regarding treatment options and what those options could mean for them.  

You don’t always have the time you think

My friend recently reminded me that there is a opportunity to place an amendment to our Advanced Directives. What if we begin declining in cognitive ability and never know it and we could not work with our healthcare provider to write a POLST. Our wishes would then be left to others that may not share the same philosophy as we do. Also, some of the nuances that could be in a POLST may not be in our advanced directives. The more you articulate your wishes, the better.

How do we prepare to write this amendment? We first must think clearly and rationally about what is best for ourselves and others that will be responsible for us in case we can’t speak for ourselves. Religion or science may guide our views but unless it is written down, witnessed and discussed it will be left to chance. One must be fully functioning and cognitively intact if the information is to be recognized.

For the purposes of the amendment, it could read something like this. If you are reading this because I have dementia, please understand that I don’t wish to prolong  my living or dying, even if I seem relatively happy and content.

Or if you have religious or other convictions and want everything possible done for you, it could read like this. I would like everything done to preserve my body regardless of whether I can make my own decisions or not.

There are also issues around how people define terminal illness. You may want to specifically spell out that you believe dementia or Alzheimer disease is a terminal illness and you would like your wishes to guide the care you receive as if you have a terminal illness, even if you are unable to make the choice. This will make it clear.

If your loved ones and healthcare provider know you consider dementia to be a fatal illness, then you could have a POLST in place.  Again, things vary state to state and country to country.  Please be sure to check.

Examples you could use

Remove all barriers to a natural death, including medical procedures or drugs.

Provide me with Comfort Care Only, including pain medication if I am in pain.

I do not wish any attempt at resuscitation.

Do not transport me to the hospital.

Do not place a breathing tube in me.

With these wishes well documented, the healthcare provider would have the information needed to complete a POLST if one was not done earlier. This information is SO IMPORTANT as we are still in the midst of a pandemic where health can change very quickly.

Life priorities

Write it down, talk to your loved ones and share the written document that has been witnessed and signed with your physician, attorney and the person that would be your proxy/guardian and have it placed with other important documents. In my previous post, I discussed Dr. Pericoyle’s work on sharing your bucket list with your healthcare provider.

It’s your choice and you should choose now.

References

POLST vs. Advanced Directives

https://polst.org/wp-content/uploads/2019/05/2019.04.30-POLST-vs-ADs-chart.pdf

Who’s That? | Kimberly Paul | TEDxAirlie. (a TED talk on the elephant in the room – death)

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Sandi Feaster

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