Choosing Your Healthcare for End of Life

By Cate Kortzeborn

My mom, 88 stubborn years old, still lives on her own in a big house with a cat that loves to get underfoot. Because I work in healthcare, I have an all-too-vivid recognition of the perils that can befall someone in her situation. So, posted on her kitchen bulletin board is a bright pink sheet of paper called a POLST.

POLST stands for Physician Order for Life-Sustaining Treatment. It’s a document that makes your treatment wishes known to doctors, nurses, emergency medical technicians, and other healthcare providers. Too often, people near the end of their lives get treatment they don’t want.

Also, family members sometimes have their own ideas about what types of treatment their loved ones would want. POLST makes sure your family members and caregivers know exactly what life-saving treatments you do and do not want. Doctors say any seriously ill person should have a POLST (but it) is completely up to you. It’s your choice.

POLST is different from an Advance Healthcare Directive (that) allows you to choose the advocate you want to speak for you if you’re incapacitated, and provides a general guide to what treatment you want.

POLST:

• Is a signed medical order that your healthcare team can act upon, whether your advocate is there or not;
• Indicates your exact wishes about certain medical treatments.

Any adult, especially if she or he is unmarried, should have one or both an Advance Healthcare Directive (AHD) and a POLST.

You can find the POLST form online or at your primary care provider’s office. Your provider can explain the different options on the form to you. It must be signed by a licensed healthcare provider and by you or a Legally Recognized Decisionmaker

This then becomes part of your medical record. It stays with you all the time. If you’re at home, put it near your bed or on your refrigerator. If you’re in a hospital, nursing home, or assisted living facility, it’ll be in your chart or file. If you’re moved between locations, it goes with you.

POLST focuses on three types of interventions for which you can choose a level of intervention.

1. Resuscitation — person has no pulse and is not breathing. Cardiopulmonary resuscitation, or CPR, involves chest compressions and/or electrical shock to restart your breathing and heartbeat after they stop. You can choose to accept or decline resuscitation.
2. Medical intervention — person has pulse and/or is breathing.

Check One: (From the California Emergency Services Authority form EMSA #111 B)

• Full Treatment — primary goal of prolonging life by all medically effective means.
• Selective Treatment — goal of treating medical conditions while avoiding burdensome measures.
• Comfort-Focused Treatment — primary goal of maximizing comfort.

3. Artificially administered fluids and nutrition.

Check One: (From the California Emergency Services Authority form EMSA #111 B)

• Long-term artificial nutrition, including feeding tubes.
• Trial period of artificial nutrition, including feeding tubes.
• No artificial means of nutrition, including feeding tubes.

It’s important to fully understand these and other options, so make sure you talk to your doctor, nurse practitioner, or physician assistant before you make any decisions. You can then choose what treatment options you want and don’t want. You can also adjust your POLST at any time, as circumstances change.

For more information and download forms, go to www.polst.org.

More information on Advance Directives can be found at: https://medlineplus.gov/advancedirectives.html.

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Cate Kortzeborn is Medicare’s acting regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).