While many people were upset that a nurse in a California long-term-care home refused to do CPR on a fallen resident last month, others say they’re more worried they or their loved ones might be resuscitated against their wishes.
It’s not a complete surprise to find that many Northwesterners want control at the end of their lives. After all, voters in 30 of 39 counties passed a measure in 2008 allowing doctors to prescribe lethal medication requested by terminally ill patients — the second such law in the country, after Oregon’s.
“I would never agree to live in a facility that would not honor my requests for end-of- life care,” said Sharon Thayer, 73, of Edmonds. “If I’m a frail 87-year-old, I don’t want somebody pounding on my chest and breaking my ribs. And If I find out there is some kind of ambiguity about it, I would find another facility — I feel that strongly about it.”
But under current state laws, whether patients’ wishes are honored in a critical situation depends on where they are and who responds to the emergency. And that doesn’t sit well with many people, including state lawmakers who are pushing for change with House Bill 1000, which passed the House Monday night.
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After Thayer read about the California case, she noted that residents of this state, in collaboration with their doctors, can sign a form called a POLSTthat directs medics to skip CPR.
The POLST (Physician Orders for Life Sustaining Treatment) is different from an advanced directive, which generally outlines a patient’s end-of-life wishes and may be filled out years before the end of their lives. Nor is it a health-care power of attorney, which specifies a surrogate decision-maker to step in if the patient can’t make decisions.
The two-page POLST is typically signed as a patient faces imminent end-of-life decisions, and speaks succinctly to such issues as whether a patient wants to be resuscitated.
The bright-green form, also signed by the patient’s doctor, has been promoted by medical leaders and the state as the standard vehicle for directing emergency end-of-life measures. Over the past several years, it has become the de facto form for patients who want to die naturally, hospital and long-term-care representatives told lawmakers during a hearing on the legislation.
But the law that created the POLST form protects only emergency medical technicians — not other health providers — from legal liability, a problem lawmakers are now tackling.
When a patientsigns a POLST with his or her doctor, often both believe they have done what’s needed to specify wishes for emergency treatment, said Laird Pisto, of MultiCare Health System and the Washington State Hospital Association.
But in fact, they are both mistaken, Pisto told lawmakers.
Emergency-room providers can’t safely honor the wishes of a patient expressed in the POLST form, he noted. And most facilities for long-term care, periodically warned by the state about potential liability, say their default is to call 911 and start CPR until an emergency medical responder arrives.
“When the POLST is put in front of us, it’s a very difficult situation to say to the family, ‘That only applies to the emergency medical responders, but not to us in the hospital.’ But that is the fact — that is the law as it stands today,” said Pisto, who also testified on a similar bill in the Senate, SB 5562.
That isn’t what many people say they want.
“I just think it’s madness that you can’t say what you want and have it carried out,” said one 76-year-old Seattle-area woman, who has read widely on the subject, in part because family members work in medical fields. “It just seems like a losing battle to get what you want.”
The whole point of expressing your end-of-life wishes, said Charlette Haugen, of Seattle, is that those wishes should be respected when the time comes.
“I think many patients out there would be disturbed that their health-care directives were not or would not be followed,” Haugen said. “Why should patients bother to think these things through, complete the forms, make sure their health-care facilities have them, only to be ignored?”
Advocates for seniors and representatives from hospitals and long-term-care facilities say health-care workers want to carry out patients’ wishes, but are fearful of legal jeopardy.
In the California case, the nurse in the independent-living unit who refused to perform CPR said that was the facility’s policy, but the family of the 87-year-old resident said she would not have wanted resuscitation.
Rep. Jim Moeller, D-Vancouver, has been working to refine the law for years. Washington is the only one of more than a dozen states with similar laws that doesn’t protect a wide range of providers, advocates said.
Rep. Jamie Pedersen, D-Seattle, who chairs the House Judiciary Committee, says he’s worried that expanding immunity for those following a POLST form might create conflict with advance directives signed earlier by the patient, because the form can be signed by a surrogate decision maker.
He doesn’t want a relative to be able to swoop in at the last minute and sign a POLST form that overrides and contradicts a patient’s wishes, he says.
“What I’m concerned about is that we have not reconciled the current structure of advance directives with the POLST form,” said Pederson, who offered an amendment to the bill. “I just want to make sure the people who did the advance planning get their wishes respected, too.”
Very likely, he conceded, the bill now being considered, if passed, wouldn’t solve all problems. “But we’ll get closer to a world where the POLST will get followed, and probably that will make it easier for a lot of people to have their wishes respected,” he said.
Carol M. Ostrom: firstname.lastname@example.org, 206-464-2249, or at Twitter @costrom