POLST: No Ordinary Advance Directive

Me

Medicare started paying for conversations about “advance care planning” in January 2016. Prompting refusal of medical treatment is the main reason for these discussions with patients in doctors’ offices, hospitals, nursing homes, and even in people’s homes. The goal is to get patients to utilize an insidious “planning” tool called POLST—Physicians Orders for Life-Sustaining Treatment. (POLST has various names and acronyms, such as MOST, COLST, POST, etc.)

The POLST is a brightly colored form with check boxes next to options such as “do not attempt resuscitation,” “comfort interventions only” (another name for hospice), “no medically assisted nutrition/hydration,” etc. There are also options to select the kinds of treatment you do want, but they are just for show. At the top of every POLST form is the statement: “Any section not completed implies full treatment for that section.” Thus, you don’t need a POLST if you want treatment.

Imagine that a kindly nurse or social worker (or some other “POLST facilitator”) sits by your hospital bed discussing “reasonable” treatment choices. She might ask, “Would you want to be kept alive on a machine?” Or, “Would you ever want a feeding tube?” She might very persuasively explain, “When food and water are not given, you will die naturally from your chronic illness. You will not feel hungry, and you will receive good care to make you comfortable.”1 (This is untrue propaganda). You answer her questions and sign the paper she has filled out. There may be no witnesses, but you have just signed a very powerful advance directive.
POLST only makes sense if a person wants to die without medical treatment the next chance they have to die. It does not matter why you need medical treatment. For instance, you could have a peanut allergy and suddenly be gasping for air. This could be easily remedied, but, if your POLST says “no breathing machine” you will die.

A POLST is no ordinary advance directive. The “facilitator” will present your POLST to a designated health care professional who will sign it. Presto! Your POLST is now a set of medical orders that go into effect immediately. In most states, medical providers are excused from discipline, medical malpractice, or criminal charges as long as they follow the checkboxes on a POLST. They don’t have to make a diagnosis or discuss treatment options with you or your health care agent or family.

RED FLAG: POLST is endorsed by Compassion & Choices, leading promoter of assisted suicide. C&C’s website calls POLST “the strongest, most explicit form of patient directive.”

Completing a POLST is always voluntary. It is advisable to firmly state, “I have a health care agent (see Living Wills, p. 13) who will make decisions for me if I am unable to do so. Until such time, I want to discuss my condition and treatment options with my attending physician when decisions need to be made. Please respect my wishes.”

By Sara Buscher, Esq.
Ms. Buscher, attorney and CPA, has served the elderly and people with disabilities throughout her professional career.

Julie Grimstad, LPN, Patient Advocate

INFORMATION:
“The POLST Paradigm and Form: Facts and Analysis,” by Christian Brugger, PhD, et al,
The Linacre Quarterly 80 (2) 2013, 103–138,
http://forum.cathmed.org/assets/files/POLST_Paradigm_and_Form.pdf

1 North Texas Respecting Choices Advance Care Planning Fact Sheet “Tube Feeding: What you should know,” http://www.northtexasrespectingchoices.com