Think about and act now on the big health issues that come down the road
There must be a reason, one that’s beyond me, why so many people avoid filling out basic legal forms for end-of-life issues, like the durable power of attorney for finances and the advance directive for health care.
The theory seems to be that if you don’t talk about getting old and (shhh!) dying, it will never happen.
Well, surprise! We can all look forward to the same end. How we get there, however, speaks volumes about our midlife maturity.
Simply put: Face the facts, ladies and gentlemen. Get these forms filled out and you can relax. At least, for a while.
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Let’s assume you’ve gone to an elder law attorney or you’ve downloaded the paperwork. At the least, you have a designated spokesperson who knows your end-of-life wishes, from try every treatment possible to let me go in dignity.
You think you’ve got your bases covered but here comes a fly ball from left field: None of these documents will assure you do not receive unwanted hospitalizations or medical treatments.
Consider a recent article in the New York Times that detailed a family’s struggle after a cardiologist inserted a pacemaker in a man who also had Alzheimer’s. The pacemaker kept his heart beating long after his mind was ready to die.
Futile treatments for this man frustrated his family and caused him additional physical suffering.
What he needed was a POLST form, says Deb Patricio, director of inpatient services for Monarch Healthcare and co-head of Orange County’s POLST coalition.
Q. What is a POLST form?
A. Patients with the Physician Orders for Life-Sustaining Treatment (POLST) basically say they wish to receive care primarily focused on relieving pain and suffering. This form is meant to be a tool for people to communicate end-of-life wishes.
Q. So do I sign up now?
A. No. POLST is meant for somebody who is expected to die in a year or less. It is helpful in defining treatment for terminal conditions rather than the advance directive, which we all should have. The advance directive would tell the physician what type of care you want if you have a heart attack, for example. POLST is for terminal care when treatment like a pacemaker, for instance, does not provide any hope of improving the patient’s outcome.
Q. POLST has been the law in California and, you tell me, about 32 other states. How does this work?
A. The form has to be signed by you or your surrogate agent (named in your advance directive) and a physician. Any hospital staff is mandated to follow the directive. You do not have to sign this yourself if you physically or mentally cannot do it. If you have an agent who knows your end-of-life issues, the agent can sign the form for you.
Q. The Journal of the American Geriatrics Society just published a study that found 98 percent of nursing home residents with POLST forms requesting fewer medical interventions still received identical treatment for pain and other symptoms.
A. Correct. POLST was first developed in Oregon in 1990 in response to concerns that traditional Do Not Resuscitate (DNR) orders and advance directives don’t adequately communicate patients’ wishes for the many treatment decisions they face at the end of their lives.
We’re trying to make more Californians aware of the program and to teach medical providers how to talk with families about POLST and end-of-life care.
Q. The study shows only about 12 percent of nursing home patients, for example, want intensive care. But the POLST form guarantees they will get all that care if they choose it?
Q. Most of us want all the treatment we can get to make life better. But when the outcome is a foregone conclusion, we just want to be comfortable. POLST gives us that reassurance?
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Jane Glenn Haas writes for The Orange County (Calif.) Register. E-mail her at firstname.lastname@example.org