A hearing before a Washington State Senate Committee yesterday revealed that, without immunity, healthcare providers are reluctant to comply with POLST and resuscitate residents contrary to their wishes.
Washington probably should provide immunity for good faith compliance with POLST. But even if the absence of such immunity, it is probably legally safer to comply with the POLST than to ignore the POLST. In this in-progress article, I am trying to show that administering unwanted life-sustaining treatment is not a legally safe approach.
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Because the States did not clarify the protection of "choice to live" and "choice to die" of the 1991 Patient Self Determination Act, the PSDA is often being violated as regards either choice.
There appears to be NO procedural protection for the choice to live because physicians (treating physicians and hospitalists) apear to be able to place oral and unwitnessed and influenced DNR Code status in the patients' hospital charts.
Because States have not required Hospitals to SEEK FORMAL and witten and informed consent from patients or surrogates for the NO CPR/DNR Code status, patients are losing their autonomy to choose because of fiscal realities.
It appears that the lack of formal permission to shorten the life of the patient also results in the act of ignoring the right of the patient to choose to shorten his/her life that has been formalized.
I'm sure, however, that when the patient's wish to shorten his/her life to shorten suffering is ignored, the hospital is almost always certain that CMS and the private insurers will reimburse them for the costs!
We need some sunshine on this matter. There is noise in the Congress about the PSDA but the Congress does nothing to protect the rights of the patients in the for-profit health care system.
The Bioethicists have also ignored the hostile environment in which the elderly are treated because of reimbursement realities that are hidden from the public and the patients --And because of lack of FORMAL procedural consent to "NO CPR" and the DNR Code Status.
Strange that patients have to consentto everything in the hospital with their signature except the "NO CPR/DNR Code Status."
In an Article (Hospital Do-Not-Resuscitate Oreers: Why They Have Failed and How to Fix Them) published by the Journal of General Internal Medicine in Feb 2011, the authors discuss how "Physicians inappropriately extrapolate DNR orders to limit other treatments."
Undortunately, this Article does not clearly reveal the connection of fiscal futility to DNR Code Status and overtreatment and undertreatment realities facing elderly patients.
However, the authors do indicate that "These strategies (outlined in the article) could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient self determination and avoiding non-beneficial interventions at the end of life."
Why NO CALL for a clarification of the 1991 PSDA and an Executive Order mandating that treating physicians SEEK informed consent for one legal standard of care or the other; i.e. Curative Care or Palliative Care and Hospice?
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