Physician orders protect your wishes

In January’s issue of “The Other Side of 50,” I shared information about advance directives and suggested that you consider filling one out as a gift to your family, because it outlines your wishes in the event of a medical emergency.

If you or a loved one, however, suffers from chronic illness, frequent hospitalizations and advancing age, there is a bright pink legal document called a POLST that mandates that these wishes be honored.

POLST stands for Physician Orders for Life Sustaining Treatment. It defines through a doctor’s orders your specific requests in three areas:

• First, if you are found without a pulse or blood pressure would you want CPR performed – chest compressions, artificial breathing, shocking of the heart? Or would you choose not to be resuscitated?
• Second, if you are in need of hospitalization, would you want aggressive interventions such as being placed on a ventilator (the breathing machine) with care in the intensive care unit or would you want basic care with IV fluids and IV antibiotics? Or if your quality of life has deteriorated significantly, would you want comfort care where control of pain, shortness of breath or other symptoms is the primary goal?
• Third, if you are unable to safely eat due to a stroke or a coma, would you want to receive nutrition by a feeding tube?

The POLST is a powerful legal document that must be honored by emergency or hospital personnel across the state. Most states across the nation have established a POLST or similar document.

To be legal and valid, however, the POLST must be signed by both the physician and the patient, if the patient has capacity to make decisions. If the patient does not have capacity, then the agent for health care decisions can sign the form.

It can and should be reviewed periodically with your doctor. The actual bright pink form should be displayed on the refrigerator or next to the bed so emergency personnel can readily find it at a time of crisis.

Nursing facilities frequently use the POLST so they know what to do when sudden emergencies arise with their residents. Any adult, however, who is potentially at risk for sudden critical illness or collapse can complete a POLST. If you think a POLST might be appropriate for you or a loved one, direct your questions to your primary care physician or feel free to call our service at 646-4216.

A good source of information about POLST as well as many other issues in geriatrics or end-of-life care is the Coalition for Compassionate Care of California at www.coalitionccc.org.

Dr. Terrell B. Van Aken is medical director for NorthBay Bridges, a supportive care service of NorthBay Healthcare.