POLST

POLST: Important Questions & Answers

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POLST is a name that stands for a form called “Physician Orders for Life-sustaining Treatment.”  The form is also called by alternative names such as MOLST, POST, MOST, etc., depending upon the state in which it is filled out.

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POLST Program Legislative Comparison
(American Bar Association — January 1, 2014)
Information on POLST in 24 states.

2014 POLST Legislative Guide
(National POLST Paradigm Task Force — 2014)
Discussion of POLST by NPPTF which supports its national implementation.

White Paper
“The POLST paradigm and form: Facts and analysis”

(Linacre Quarterly — 2013)
An extensive analysis of POLST including its origins, legal status and implementation.

For additional information about the POLST, MOLST, POST or MOST form,
enter one of those terms
into the “Search Site and/or News” box on this page.

“Model POLST Statute”
(POLST: Critical Analysis and Comment — September 27, 2013)
Intended to allow individuals to use the form to effectuate their end of life treatment preferences.  Contains suggestions that include protections against abuse and the possibility of unintended circumstances.

Articles

“Catholic Health Association ethicist cautiously endorses POLST but calls for monitoring”
(POLST-views blogspot — April 14, 2014)
Ron Hamel, PhD is the senior ethicist for the Catholic Health Association of the United States….Dr. Hamel concludes by saying that “the jury is out…but premature to prohibit.” That’s an interesting conclusion, but probably the wrong one. When dealing with issues of life and death the precautionary principle should apply, and if the “jury is out” then facilities ought to wait before rushing to adopt the POLST.

“POLST’s Potential for Abuse”
(National Review Online — April 1, 2014)
With the growing technocracy in medicine, it becomes increasingly difficult for patients to have actual control over their own care.  Take the POLST, which stands for Physician’s Order for Life Sustaining Treatment.

“Illinois’ nutty POLST bill”
(POLST-views blogspot — March 31, 2014)
The bill describes who can have a POLST form:
“An individual of sound mind and having reached the age of majority or having obtained the status of an emancipated person to the Emancipation of Minors Act may execute a document (consistent with the Department of Public Health Uniform POLST form….) directing that resuscitation efforts not be implemented.”
That’s it. No suggestion that the individual be likely to die within a year.  No requirement that the individual have a serious illness or chronic frailty.

“Europe looks to LaCrosse for end-of-life model”
(La Crosse Tribune — March 20, 2014)
The Australian version, titled Respecting Patient Choices, recently received $15 million from the federal government to make it the national standard of care, Hammes said.  Wisconsin and Minnesota also have programs based on Respecting Choices– titled Honoring Choices — aiming to become statewide standards.
[Note:  Respecting Choices is a POLST paradigm program.}

"POLST Task Force repudiates extreme laws in New Jersey and Nevada"
(POLST-views blogspot -- March 10, 2014)
Perhaps the most important new position announced by the National POLST Paradigm legislative guide is the explicit rejection of the liberal New Jersey and Nevada criteria for who should get a POLST....
One disappointment in the legislative guide is the Task Force's continued refusal to say that a patient or surrogate signature on the POLST form should be mandatory.

"Rhode Island Medical Reporter Quotes Second Thoughts CT Concerns about MOLST"
(Not Dead Yet -- January 23, 2014)
Some people with disabilities fear that MOLST laws, already in place in several states, could result in denial of life-saving treatment to those who want it.  Although MOLST is supposed to be voluntary, these activists say some nursing homes have presented it as mandatory.  And when emergency personnel see that pink sheet tacked to the wall, will they read all its details or will they assume it means "do not resuscitate?"

"Health Insight: New R.I. law aims to ease final days of terminally ill"
(Providence Journal -- January 19, 2014)
Cathy Ludlum of Second Thoughts Connecticut says that "many people with severe disabilities feel personally threatened" by the law's definition of "terminal illness" as "an incurable condition that, without the administration of life-sustaining procedures, will, in the opinion of the attending physician, result in death."
"By definition," Ludlum said, "we have incurable and irreversible conditions, and many of us use life-sustaining procedures every day of our (hopefully) long lives."

"John Kelly Quoted in NPR Thanksgiving Day Article on POLST"
(Not Dead Yet -- December 1, 2013)
Some members of the disability community have questioned whether POLST is being too broadly applied. Rather than giving people more control over end-of-life medical care, they say, it could mean interpreting "disabled" to mean "on death's door."
More on Disability Perspective

"After The Cranberries And Pie, Let's Talk About Death"
(NPR -- November 28, 2013)
"We would encourage doctors to reach out to patients if they would not be surprised if they died in the coming year," Dr. Susan Tolle says, "or if they had advanced frailty. The little old lady hunched over their walker, that's the definition of frailty."
Tolle says, "People are handing out the form a little too early sometimes...."

Massachusetts: "John Kelly's Response to IOM Online Survey or 'We Love Our Tubes!'"
(Not Dead Yet -- November 7, 2013)
Three months ago, my nurse brought me the Massachusetts MOLST form, with its preference for certain treatments in extremis.  She had been told that they were to complete these forms with every disabled person she follows.

West Virginia: "Are West Virginia's doctors rejecting the POLST?"
(POLST views blog spot -- October 28, 2013)
After a decade of promotion, and millions of public dollars spent by the Center on POST promotion, it is unlikely that doctors are unaware of the form.  Perhaps they just don't like it.

Indiana: "Indiana's POLST: Go hoosiers!"
(POLST views blog spot -- October 21, 2013)
The Indiana POLST is called "POST" and it can only be offered to a "qualified person," who is defined as someone who has an advanced progressive illness, advanced chronic frailty or a condition that will cause death in a short time.

Maryland: "New form directs doctors in life-threatening situations"
(Baltimore Sun -- September 4, 2013)
Nursing homes and other health care facilities/programs are required to offer the Medical Order for Life Sustaining Treatment (MOLST) form to patients when they are admitted and to send it with the patient on transfer to another institution. The receiving institution is required to honor the form.
[Note: The MOLST form does not require the signature of the patient or the patient's surrogate.}
Text of MD MOLST law
MOLST form

"Who is getting DNR orders on a POLST? More people than you think!"
(POLST views blog spot -- August 7, 2013)
The National POLST Paradigm Task Force says that in order to determine whether a person should have a POLST, a clinician should ask, "Would I be surprised if this patient died in the next 12 months?"
[To access this article, see August listings in right column of page on the site]

“New form adds some teeth to end-of-life care preferences”
(USA Today — August 5, 2013)
Cathy Ludlum, one of Second Thoughts Connecticut’s leaders, said the POLST program may seem to increase patient options at first, but it actually limits those options by steering elderly people and people with disabilities toward death.

“Nevada’s new POLST statute: One more step down the slippery slope”
(Critical Analysis and Comment Blog — August 5, 2013)
The Nevada POLST is not limited to individuals who are near death. The NV law mandates that doctors offer a POLST to certain patients….”The subtle message that some will receive is that a ‘good’ patient should sign a POLST.”
Text of NV POLST law.

“A Novel Way to Document End-of-Life Preferences”
(New York Times — July 25, 2013)
To increase the number of patients who had documented their end-of-life preferences — including having a POLST that would be scanned into the patients’ medical records — a cash incentive was provided to medical residents.  If the residents recorded the information for at least 75 percent of discharged patients, they received a cash bonus.  Within months, 90 percent of patients’ preferences had been documented.

“In Response to Professor Thaddeus Pope’s article ‘Dangerous Catholic Attack on the POLST’”
(Bioethics.org — July 25, 2013)
Professor Pope asserts that “a number of scientifically rigorous studies have demonstrated POLST’s material benefits.” This is an exaggeration….[W]e are now seeing POLST statutes in New Jersey and Nevada that recommend the POLST for individuals with five years of life expectancy regardless of health.

White Paper
“The POLST paradigm and form: Facts and analysis”

(Linacre Quarterly — 2013)
An extensive analysis of POLST including its origins, legal status and implementation.

Not Dead Yet comments on POLST
(NDY press release — July 23, 2013)
Not Dead Yet provides video and written comments on POLST to the Institute of Medicine’s Committee on Approaching Death.
“‘How do we know the POLST medical order actually reflects the desires of the individual?’ [We worry] that, depending on how POLSTs are presented, they can make life-sustaining treatments — such as the use of feeding tubes — seem unbearable, even though many disabled people are able to live full lives because of them.”

“POLST — Need for Statutory Immunity”
(Medical Futility Blog — July 21, 2013)
Many question the need for statutory immunity for following the orders in a POLST. They argue that, through clinical consensus, clinicians can get the same thing by establishing POLST as the standard of care. But as debates in Washington state, this year, illustrated, this is often not perceived as sufficient.

“Dangerous Catholic Attack on POLST”
(Bioethics.net — July 19, 2013)
Most recently, the Catholic Medical Association, the largest association of Catholic individuals in health care, published a scathing attack on POLST.

“Not Dead Yet News & Commentary”
(Not Dead Yet — June 21, 2013)
Overview of disability rights spokesperson concerns about POLST

“POLST Authorizes Unilateral DNAR Orders”
(Medical Futility Blog — June 15, 2013)
In both Maryland and Vermont, a clinician can write a POLST order indicating “no CPR” even without patient or surrogate consent.

“New Form Helps Clarify End-of-Life Decisions for Patients and Families”
(NJ Spotlight — February 25, 2013)
The state is recommending that doctors and nurse practitioners complete this form with all patients who have a life expectancy of fewer than five years….When a POLST is completed, it travels with the patient and will ultimately be part of his or her electronic medical record as providers implement them. It has the force of a medical order, which means all healthcare providers are required to follow its instructions.
New Jersey POLST form

“Bill tackles loophole in law on end-of-life wishes”
(Seattle Times — February 24, 2013)
[L]ast summer, questions arose as to whether workers in those facilities were legally safe in following patients’ wishes as spelled out in the POLST form, said Joyce Stockwell, director of residential care services for the Department of Social and Health Services, in her letter warning adult-family-home providers their workers might not have legal protection.

Congressman Earl Blumenauer plans to reintroduce his controversial advance care planning legislation.  His earlier attempt, included in Obamacare, was deleted prior to final passage after being labeled as promotion of “death panels.”  Blumenauer is a supporter of Oregon’s assisted-suicide law and has been a featured keynote speaker for the assisted-suicide advocacy group, Compassion & Choices:
“Blumenauer turns again to end-of-life care, after mom’s death”
(Oregonian–February 16, 2013)
“In a bill Blumenauer plans to introduce by spring, Medicare and Medicaid would pay for voluntary consultations between doctors and patients about end-of-life wishes The bill would Provide grants to promote ‘physician orders for life-sustaining treatment’ [POLST]….”  Text of draft bill.

“The Deadly Failure of a Hospital to Follow a Patient’s Decisions About his Medical Care”
(Disability Rights California — February 2013)
Hospital neglected to provide medical interventions consistent with Mr. turner’s POLST when his physician revised his POLST form to say the opposite of the patient’s expressed wishes to receive life-sustaining treatment.

Medical Orders for Life-Sustaining Treatments (MOLST) Forms”
(Delaware Health and Social Services – Department of Health — November 14, 2012)
The State of Delaware division of Public Health, requests that all healthcare providers refrain from further use of the MOLST form.  There have been reports of facilities and healthcare providers completing “MOLST” forms on patients whose conditions do not meet the legal parameters for the form’s use in the state.

“POLST: An Emerging Model for End-of-Life Planning”
(The Elder Law Report — February 2009)
“With poor training, inadequate resources, and insufficient evaluation, the [POLST] process can regrettably morph into another systematic trampling of patient autonomy.”
[Quotation found on page 5]