By Julie Grimstad
The POLST (Physician Orders for
Life-Sustaining Treatment) form is a standard document that, when signed by a
designated healthcare professional, dictates whether to withhold or administer
certain forms of medical treatment and/or care. POLST is known by different
acronyms in various states (MOST, MOLST, POST, etc.).
A brightly colored form that is
very visible in a patient's medical chart, POLST has boxes to check off indicating
that a patient does or does not want cardiopulmonary resuscitation (CPR),
antibiotics, nutrition and hydration, etc. Trained "facilitators"—usually
not physicians—discuss treatment options with patients. After filling out the
form with a patient, the facilitator presents it to be signed by a designated
healthcare professional—someone who may never have seen or talked to the
patient. The completed POLST form is not simply an expression of a patient’s
treatment preferences; it is a set of physician's orders which must be
followed.
POLST medical orders travel with
the patient from one healthcare setting to the next and even home to be
followed by EMT's in the event of a medical emergency. The first order in many
POLST-type forms is "FIRST follow these orders, THEN contact Physician,
Advanced Practice Nurse, or Physician Assistant for further orders if
indicated."[i]
POLST is tilted toward
non-treatment and can encourage premature withdrawal of treatment from patients
who, but for the denial of treatment, would not die. Facilitators present
options for treatment as if they are morally neutral, even though certain
decisions may lead to euthanasia by omission. Groups that promote euthanasia
and assisted suicide, such as Compassion & Choices (formed by the merger of
Compassion in Dying—a Hemlock Society spin-off—and End of Life Choices),
strongly endorse POLST. This is a big RED FLAG.