Advance Directives—and Physicians Order on Life-Sustaining Treatment

by Joanna Smith on May 7, 2009

For years there have been “Advance Directives” that you could fill out to state what your wishes were about care for yourself should there be a time when you could no longer state your wishes.  Advance Directives allowed people to appoint agents to make healthcare decisions on their behalf, and to state the kinds of care they would wish to have.

In the Beginning….

In California, as in some other states, a resident could also register their Advance Directive with the Secretary of State on a secure web site.  Emergency rooms could check that web site and see if there was an Advance Directive and locate the agent.  The only problem seemed to be that people didn’t want to think about Advance Directives when they’re healthy, and frequently when they become ill, there wasn’t the time or focus to complete one.

In addition, there were problems with Advance Directives.  One problem with Advance Directives was that they didn’t carry the weight of a Physician’s order. If you called 911 in an emergency, when the emergency team arrived, they would still be obligated to do everything possible to save a life—even if there was an advance directive in place.  They actually needed a physician’s order to stop extraordinary treatments like CPR.  Once you activated 911, you set a chain of events in play that were hard to stop.  Various solutions were tried to solve this problem (the Pre-Hospital DNR was one attempt), but, again, most people didn’t get them filled out.

The New Approach

As of January 2009, California joined the states of Washington, Oregon, North Carolina, Tennessee, West Virginia, New York and parts of Wisconsin in becoming a “POLST” (Physician’s Orders for Life-Sustaining Treatment) state.  It is another step in trying to ensure that your wishes are acted upon.

What is POLST?

A POLST is actually a set of orders, signed by your physician and you that cover issues such as whether you want to have medical personnel try to restore your heartbeat or whether you want to be fed through a feeding tube.  Since these are Physician’s orders, they can be followed by emergency medical personnel “in the field” (i.e., outside of a clinic or hospital setting).  These orders are generally put in place in the last year or so of a person’s life.  It’s a good step forward.

How to you get these orders?  Your doctor will know about them, and you can also download the form itself from the various web sites.  Check the national POLST web site or in California, the site for the California Coalition for Compassionate Care. Talk with your healthcare provider about this form and you both can decide if it’s appropriate for you to complete.

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