Later this month, the IOM Committee on Approaching Death: Addressing Key End of Life Issues will hold its third meeting in Houston.
The agenda includes sessions on (1) clinical ethics, (2) addressing spiritual and religious issues, and (3) empirical and legal issues regarding POLST. Here is the description of the POLST session.
Critical overview of empirical evidence regarding the impact of POLST on clinical care and
outcomes. Does POLST lead to fewer days in the Intensive Care Unit in the last week of life,
CPR before death, etc.? Do states that have robust POLST programs have different levels of
specific medical interventions in end-of-life care? Does POLST reduce disputes regarding end-of-life decisions? Does POLST prevent complicated grieving by survivors or decision regret?
Susan E. Hickman, PhD
Associate Professor, Indiana University School of Nursing
Co-Director, RESPECT Signature Center, IUPUI
Senior Affiliate, IU Health Fairbanks Center for Medical Ethics
Challenges and limitations in advance care planning and POLST, with particular attention to
vulnerable patients. The importance of conversations in advance care planning as well as
documentation of orders and the challenges in improving these conversations.
Rebecca Sudore, MD
Associate Professor of Medicine
University of California, San Francisco
What legal issues might present challenges to a patient and family who wish to use the POLST
form or other types of advance care planning? May a surrogate complete a POLST for a patient
who has already lost decision-making capacity? Are there restrictions on using POLST to
decline feeding tubes in patients with severe dementia or stroke? Are these limitations
communicated effectively to patients and families using POLST? Have there been cases
involving POLST in the courts? What other legal approaches to advance care planning have
states implemented, such as default priority for surrogates and oral appointment of health care
proxies, and how have they worked in practice?
Alan Meisel, JD
Director, Center for Bioethics and Health Law
Dickie, McCamey and Chilcote Professor of Bioethics, and Professor of Law and
University of Pittsburgh