When terminally ill patients can no longer speak for themselves, decisions can get complicated in the health care system. A bill recently signed into law by Governor Arnold Schwarzenegger attempts to ensure that those patients‘ wishes are honored.
The law, authored by state Representative Lois Wolk (D-Davis), provides terminally ill patients with a mechanism to clearly indicate specific end-of-life health care instructions.
It requires heath care providers to honor the wishes of patients with less than a year to live as outlined in a Physician‘s Order for Life Sustaining Treatment form. The POLST form, which is new to California but routinely used in 15 other states, allows patients to give specific instructions for end-of-life care such as resuscitation, pain management, artificially administered nutrition and relocation to the hospital from the patient‘s home.
“The POLST represents a conversation that has taken place between a doctor and a patient at the end of life so that the person‘s wishes can be followed,“ Wolk said.
The bright pink sheet stays with patient at all times and is intended to provide consistent care as the patient moves through skilled nursing facilities, hospitals and emergency rooms with different health care providers.
“Currently, end-of-life care is extremely fragmented,“ Wolk said. “There is fragmentation between emergency personnel, the doctors, hospitals and assisted living. What happens is the person who is dying suffers and their family suffers.“
It was Wolk‘s personal experience with end-of-life care during her mother-in-law‘s hospitalization that prompted her to write the legislation.
“I‘ve always been interested in senior issues but it took on new urgency after the death of my mother-in-law,“ she said. “I‘ve become much more aware of how many other people have experienced similar kinds of fragmentation.“
The POLST form – which can be changed by the patients or their designated surrogates at anytime – will not replace advanced health care directives or do-not-resuscitate orders, but is intended to supplement them in more detail. Most advanced health care directives only name a decision-maker for the patient and are usually stored in files or safe deposit boxes unavailable during emergency situations, according to the senate analysis of the bill.
“[POLST] has the effect of doctor‘s orders and neither the DNR nor advanced health care directive do,“ Wolk said. “It complements them, but has the effect of doctor‘s orders, which is what matters in hospitals.“
Woodland and Sacramento are among eight California communities currently working to implement POLST through a pilot project funded by the California HealthCare Foundation. The Woodland Healthcare Foundation received a $20,000 grant in November of 2007 to facilitate the use of the form in both hospitals and skilled nursing facilities.
“All these different groups are working to institute POLST in the community,“ said Joanne Hatchett, a nurse practitioner and palliative care coordinator who leads the Woodland project. “The goal with POLST is to define what you want and what you don‘t want so people can follow that.“
Implementing POLST in Yolo County has gone smoothly largely because nursing homes and hospitals have been using a form almost identical to POLST for several years, Hatchett said.
Hatchett estimates that over 100 patients have filled out a POLST during the pilot project.
“It‘s not an easy form for people to talk about because it‘s not an easy subject,“ she said. “ Sometimes people don‘t want to talk about this stuff but it‘s actually like a gift to your family because then they‘re sure about what you want.“
The bill passed both the Assembly and the Senate unanimously without any registered opposition.
ALYSOUN BONDE can be reached at email@example.com.