A Medical Professional’s Reflection
Max Diamond, M.D., Mary-Kate Kelledy, J.D., Kendra Oliver, MBA
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Situation
California launched the Physician Order for Life Saving Treatment (POLST) Form on January 1, 2009. Today, the POLST Form remains established as the standard method of advanced medical care planning for persons with advanced illness or frailty near the end of life.
The POLST form is not just a form; it is a tool for medical providers to administer individualized, compassionate care. At a time when patients likely feel helpless in many respects, the POLST form entrusts them with the freedom to discuss and define their own quality of life, individually.
Case Study
A REFLECTION…
Each hospice patient we encounter is important and unique. Similar diagnoses can have predictable outcomes, but we must never assume that patients will have the same experiences, want the same treatments, or understand what “quality of life” is in the same way. For me, as a care provider, I must surrender my own ideas about “quality life” and fully support my patients in their own understanding of what makes life beautiful to them.
For example, I once cared for a 96-year-old patient who was gravely ill. She was disoriented, quickly declining after a long illness, and could no longer eat on her own. Her family wanted to begin artificial nutrition through a g-tube. To be honest, this is not the choice I would personally make for my loved ones, but the decision was not mine to make or to influence. As her medical team, we discussed the potential negative consequences and generally of no real benefit at this stage of life, including discomfort from the placement of the tube and the risk of complications, but the family was confident in their decision, the patient indicated her consent, and nutrition/hydration was started.
Weeks went by. Our patient became less responsive and died peacefully with her family at bedside. It would be easy to look back and critique her eight weeks as simply “lingering...” But to do so would negate the value of the experience she and her family had together in those final days. While she lay motionless in her hospital bed, with barely the strength to open her eyes, memories and laughter were shared, hands were held, tears shed, prayers lifted heavenward, and steps toward mutual forgiveness granted. I cannot measure the “quality” of her life in those last weeks, but the quality of her death cannot –should not— be denied.
Kendra Oliver, MBA
Here, the physician still guides the conversation by applying their own expertise but broadens the scope of the questions with more detail to define the patient’s end-of-life needs more succinctly.
Another article of this series on POLST will explore “The Hard Facts about Survival Rates.”
References
1. POLST Education. Retrieved October 2018 from https://familydocs.org/eol/education/polst
2. California POLST Form. Retrieved September 2018, from https://capolst.org/wp-content/uploads/2017/09/POLST_2017_Final.pdf
3. The Physician Orders For Life-Sustaining Treatment (POLST) Coming Soon To A Health Care Community Near You, Robert B. Wolf, Marilyn J. Maag, and Keith Bradoc Gallant, Retrieved October 2018 from http://www.polst.org/wpcontent/uploads/2014/11/WolfMaagGallantVol49No1.pdf
4. The Coalition for Compassionate Care of California. POLST for Healthcare Providers. – Legislation & Public Policy. Retrieved September 2018, from https://capolst.org/polst-for-healthcare-providers/
5. California Health Care Foundation. (2009, January). CHCF Directs $2 Million to Spur Adoption of New End-of-Life Communication Tool - Recently approved POLST form gives seriously ill patients greater ability to control medical treatment. Retrieved September 2018, from https://www.chcf.org/press-release/chcf-directs-2-million-to-spur-adoption-of-new-end-of-life-communication-tool/
6. Dunn, P.M., Tolle, S.W., Moss,A.H., and Black, J.S. (2007, September). The POLST Paradigm: Respecting the Wishes of Patients and Families. Annals of Long-Term Care, 15 (9), 33-40. Retrieved September 2018, from http://www.polst.org/wp-content/uploads/2013/01/the+polst+paradigm+respecting+wishes.pdf
7. Pope, T.M., Hexum, H. (2012). Legal Briefing: POLST: Physician Orders for Life-Sustaining Treatment. The Journal of Clinical Ethics, 23(4), 353-76. Retrieved September 2018, from https://pdfs.semanticscholar.org/a142/bc9501f50610297654e085eeb9752da72e34.pdf
8. IOM (Institute of Medicine). 2015. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
9. Cantor, M.D., et al. (2002, August). To Force Feed the Patients With Dementia or Not to Feed: Preferences, Evidence Base, and Regulation. Annals of Long Term Care, Volume 10, Issue 8.
For additional information please contact Dr. Max Diamond at 714-221-5182 or mdiamond@regalmed.com.