Make your end of life wishes known

When a 92-year-old patient of mine came to my office to discuss end-of-life wishes, he already had an idea to ensure that his plans would be respected. He said he would have “Do Not Resuscitate” tattooed on his chest in large letters so when paramedics came to revive him, they would see the message and stop their efforts.

It’s an amusing idea, but it ultimately wouldn’t work. Paramedics are required by law to attempt resuscitation in emergency situations, even if the patient in question has decided they don’t want aggressive actions taken.

Only a physician can give the order to hold off on life-saving measures, which means that resuscitation actions are required until the patient arrives at an emergency room. As a result, a POLST form is vital for people who, for reasons of disease or age, have decided they would like to pass peacefully.

The POLST form stands for Physician Order for Life-Sustaining Treatment and it directs EMTs, nurses and other medical personnel to follow a patient’s wishes and allows them to make that decision when they are otherwise not legally able to.

Many have advance directives that address these end-of-life issues. In fact, I encourage all my patients ages 18 and older to fill one out because they address unexpected situations, such as a near-fatal car accident, where it makes sense for every measure to be taken until the patient can be assessed by a physician who reviews the advance directive and decides whether it applies.

It’s most useful for your family because in a stressful end-of-life situation, the directive instructs what should and should not be done in a hospital setting. But what happens when you don’t want aggressive medical resuscitation at home?

In this situation, the POLST form supplements the advance directive. The POLST form is a better choice for those facing an end-of-life situation and know what they would and would not want. It’s a simple form that allows the patient to indicate whether they approve CPR, intubation, tube feeding and other life-extending measures.

Before the digital age, the POLST form was printed on a fluorescent magenta piece of paper that was designed to be taped to the refrigerator or the front door of your house or apartment so the paramedics could look for it and follow the orders. Fortunately, the information is now entered into a database and EMTs are able to access the POLST using the patient’s name and date of birth so they know what actions to take.

It is important that end-of-life decisions are respected. Filling out an advance directive and a POLST form are crucial steps for Oregon residents to ensure that their wishes are known and followed. Since Oregon is a national leader in end-of-life care processes and very few states have POLST forms, it’s vital to take advantage of these excellent end-of-life planning processes.

(Dr. Richard Segal practices internal medicine at the Kaiser Permanente North Lancaster medical office.)

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