Tuesday, January 8, 2013
Legal Briefing: POLST: Physician Orders for Life-Sustaining Treatment
With Melinda Hexum, I just published "Legal Briefing: POLST: Physician Orders for Life-Sustaining Treatment." in The Journal of Clinical Ethics 23, no. 4 (Winter 2012): 353-76. Here is the abstract:
This issue’s “Legal Briefing” column covers recent legal developments involving POLST (physician orders for life-sustaining treatment.) POLST has been the subject of recent articles in JCE. It has been the subject of major policy reports and a recent New York Times editorial. And POLST has been the subject of significant legislative, regulatory, and policy attention over the past several months. These developments and a survey of the current landscape are usefully grouped into the following 14 categories:
1. Terminology
2. Purpose, function, and success
3. Status in the states
4. Four legal routes of implementation
5. Which professionals can authorize POLST?
6. Is the patient’s signature required?
7. Can surrogates consent to for incapacitated patients?
8. If a POLST conflicts with an advance directive, which prevails?
9. Is offering POLST mandatory?
10. What are the duties of healthcare providers?
11. What is the role of electronic registries?
12. What is the role of the federal government?
13. International adoption
14. Court cases
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2 comments:
The POLST Movement is gaining steam but I have mixed emotions about it.
Obviously, the majority of States are requiring the signature of the patient and the preparer to the POLST ----which is good, and, of course, as with the Living Will, a POLST can always be changed, even at the last minute. The autonomy of the patient is protected.
However, since I believe the DNR Code Status is often misused to keep elderly and very ill patients out of ICU and CCU, I don't think anyone, but especially the very elderly, should elect NO CPR (DNR Code Status) while they are still in good health.
Many elderly patients can survive pneumonia if they have antibiotics ---and many survive even AFTER intubation with an acceptable quality of life. But, hospitals are punished by CMS if the elderly patients die in their ICUs and, therefore, there is the incentive to keep the elderly out of ICUs to begin with.
The problem of INFLUENCING THE CODE STATUS for fiscal considerations is being overlooked.
The DNR code status is a less expensive standard of care that can work against the best interests of those patients who want the RIGHT to live as long as is medically possible and personally feasible.
Yet! the bioethicists never talk about "fiscal futility" ---the elephant in the room -- when they talk about "medical futility," do they?
The POLST Movement is gaining steam but I have mixed emotions about it.
Obviously, the majority of States are requiring the signature of the patient and the preparer to the POLST ----which is good, and, of course, as with the Living Will, a POLST can always be changed, even at the last minute. The autonomy of the patient is protected.
However, since I believe the DNR Code Status is often misused to keep elderly and very ill patients out of ICU and CCU, I don't think anyone, but especially the very elderly, should elect NO CPR (DNR Code Status) while they are still in good health.
Many elderly patients can survive pneumonia if they have antibiotics ---and many survive even AFTER intubation with an acceptable quality of life. But, hospitals are punished by CMS if the elderly patients die in their ICUs and, therefore, there is the incentive to keep the elderly out of ICUs to begin with.
The problem of INFLUENCING THE CODE STATUS for fiscal considerations is being overlooked.
The DNR code status is a less expensive standard of care that can work against the best interests of those patients who want the RIGHT to live as long as is medically possible and personally feasible.
Yet! the bioethicists never talk about "fiscal futility" ---the elephant in the room -- when they talk about "medical futility," do they?
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