The Illinois Legislature updated a medical order designed to travel with seriously ill patients across care settings and direct doctors to provide or withhold lifesaving treatments. The Practitioners Orders For Life-Sustaining Treatment (POLST) form now gives any qualified medical practitioner the ability to sign and validate a patient’s form.
POLST is more detailed than conventional living wills or advance directives – these medical orders extend patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes, among other options. When first launched, the form required the signature of a patient’s attending physician.
The Illinois POLST is divided into basic sections – CPR, medical interventions and artificial nutrition. Physicians, nurses and other emergency responders are required to follow patients’ preferences as they are indicated on signed forms.
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. It is not required or to be forced upon patients.
“Advance practice nurses, physician assistants and certain medical residents (the residents need to be in their second year or above of training) can now sign the medical order,” said Dr. Julie Goldstein, a clinical ethicist and chair of the POLST Illinois Task Force, in a written statement to Life Matters Media. “I am relieved to know that this law will continue this process of enabling people who are near the end of life to be able to control their health care, even in an emergency when those patients may be unable to speak for themselves.”
State Sen. John Mulroe, a sponsor of the update, said he believes the form will help Illinois’ seriously ill take control over their end of life care.
“Sometimes the attending physician is not as familiar with a patient’s needs as other health providers are,” said Mulroe, a Democrat. “I believe there is a time and place to give the people that are dying from cancer, or some other thing, the option to say ‘don’t use any extraordinary measures to keep me alive, because right now I’m not living.’ I think the people of Illinois should have that right.”
Mulroe’s concerns were echoed by other elected officials.
“This new law allows advanced practice nurses and other allied health professionals to assist with end of life decisions. These practitioners spend significantly more time with patients,” said State. Rep. Sara Feigenholtz, a Democrat, in a statement. “Timing can be everything in these situations. Permitting other practitioners to sign these documents is key.”
State. Rep. Robyn Gabel said the legislation helps Illinois honor patients’ wishes.
“In these changing times in health care, legislators should continue to concentrate on patient need as their central focus– especially end of life decisions” said Gabel, a Democrat, in a statement.
POLST was first developed in Oregon during the 1990s, and now more than a dozen states have officially endorsed programs; more than 20 other states are considering use.
Loretta Downs, a hospice volunteer and past president of the Chicago End-of-Life Care Coalition, called the updated form “a milestone for Illinois citizens.”
“The POLST form is the most person-centered and empowering protection available for any individual who is nearing the end of their life, or at risk of receiving unwanted medical treatment,” she offered.