Seriously ill patients in Illinois may benefit from the new Physician Orders for Life Sustaining Treatment (POLST) form, a medical order designed to travel with patients across care settings and direct doctors to provide or withhold lifesaving treatments.
“POLST has swept the nation, and Chicago is right in the middle of it,” said Dr. Julie Goldstein, a clinical ethicist and chair of the POLST Illinois Taskforce. “If done correctly, the POLST model will improve conversations about end of life and ethical care.” Goldstein addressed dozens of medical providers and caregivers Wednesday during a POLST webinar in support of National Health Care Decisions Day.
In 2013, Illinois modified the Department of Public Health Uniform DNR Advance Directive to closer resemble the National POLST Paradigm standard. POLSTs are more detailed than conventional living wills and advance directives– these forms give patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes, among other things.
For instance, a terminally ill cancer patient may choose to decline resuscitation efforts, but opt for artificial nutrition. An elderly patient suffering severe dementia may opt for comfort care only.
The form is intended only for individuals in their last year of life, a point Goldstein stressed. “POLST is not for everyone. We recommend physicians ask themselves the “surprise” question: Would you be surprised if your patient died within one year?”
Ideally, patients will discuss their end of life wishes with friends and family before filling it out. “It is a process, not a single conversation,” Goldstein added during the informational call. “It allows the patient more time to think about future scenarios and discuss them with family, friends and care providers.” The Illinois POLST is divided into basic sections– CPR; medical interventions; artificial nutrition– and must be signed by a physician.
Physicians, nurses and emergency responders must also follow patients’ preferences when indicated on completed forms.
According to the Illinois Health Care Surrogate Act: “A health care professional or health care provider, or an employee of a health care professional or health care provider, who in good faith complies with a do-not-resuscitate order made in accordance with this Act … may not be found to have committed an act of unprofessional conduct.”
POLST was first developed in Oregon in the 1990s, and now 14 states have officially endorsed programs; 28 states are considering the use of these forms.