The Physician Orders for Life-Sustaining Treatment (POLST) program, designed to improve the quality of end of life care, is on its way to implementation in Illinois. A task force made up of physicians, public health officials, chaplains and nurses is currently working to assemble and educate health care workers about the form.
POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of POLST forms.
POLSTs are more detailed than conventional living wills or advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across care settings and direct doctors to provide or withhold lifesaving treatment.
Julie Goldstein, M.D., a palliative care and clinical ethics specialist at Advocate Illinois Masonic Medical Center, leads the POLST Illinois task force and spoke with Life Matters Media.
“I work at the bedside. I see the results of people not having thought about their future,” Goldstein said. “Their loved ones have to make their decisions at a loss. I think with no directives from the patient, the default approach is maximum treatment, despite burdens and if treatments can help.”
The Illinois Department of Public Health is currently looking over the proposed form. “Individuals may be able to have the POLST form by the New Year, but we don’t know for sure yet,” Goldstein said.
The Chicago End-of-Life Care Coalition, a non-profit working with the task force, maintains that every person has the right to accept or decline medical treatment. This right is maintained, POLST advocates say, even if a patient loses the capacity to make medical decisions. POLST is just one advance care option.
The POLST form is always intended to travel with a patient, whether that is in an ambulance en route to a hospital, or in the instance a patient moves into a long-term care facility.
“The POLST form differs from a DNR form in that it addresses more life-sustaining treatment options than CPR and is recognized and honored by all institutions along the healthcare continuum in the states where it is utilized,” according to the CECC.