Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-25T01:15:11.951Z Has data issue: false hasContentIssue false
  • English
  • Français

The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation

Published online by Cambridge University Press:  01 January 2021

Susan E. Hickman ,
Charles P. Sabatino ,
Alvin H. Moss  and
Jessica Wehrle Nester
Get access Rights & Permissions [Opens in a new window]

Extract

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR (do not resuscitate) protocols (n = 9 states). Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments (n = 23 states), medical preconditions (n = 15), and witnessing requirements (n = 12) for out-of-hospital DNR protocols.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 36 , Issue 1 , Spring 2008 , pp. 119 - 140
Copyright
Copyright © American Society of Law, Medicine and Ethics 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Perkins, H. S., “Controlling Death: The False Promise of Advance Directives,” Annals of Internal Medicine 147, no. 1 (2007): 51–57.CrossRefGoogle Scholar
FindLaw, , Most Americans Lack Proper Estate Planning, Says New http://FindLaw.com Survey, Press Release, available at <http://company.findlaw.com/pr/2005/051005.estateplan.html> (last visited December 12, 2007).Google Scholar
Silveira, M. J. DiPiero, A. Gerrity, M. S. Feudtner, C., “Patients’ Knowledge of Options at the End of Life: Ignorance in the Face of Death,” JAMA 284, no. 19 (2000): 2483–2488; Hoffmann, D. E. Zimmerman, S. I. Tompkins, C. J., “The Dangers of Directives or the False Security of Forms,” Journal of Law, Medicine & Ethics 24, no. 1 (1996): 5–17.CrossRefGoogle Scholar
Fagerlin, A. Schneider, C. E., “Enough: The Failure of the Living Will,” Hastings Center Report 34, no. 2 (2004): 30–42; Dresser, R., “Confronting the ‘Near Irrelevance’ of Advance Directives,” Journal of Clinical Ethics 5, no. 1 (1994): 55–56.CrossRefGoogle Scholar
Shalowitz, D. I. Garrett-Mayer, E. Wendler, D., “The Accuracy of Surrogate Decision Makers: A Systemic Review,” Archives of Internal Medicine 166, no. 5 (2006): 493–497; Ditto, P. H. Danks, J. H. Smucker, W. D. Bookwala, J. Coppola, K. M. Dresser, R. Fagerlin, A. Gready, R. M. Houts, R. M. Lockhart, L. K. Zyzanski, S., “Advance Directives as Acts of Communication,” Archives of Internal Medicine 161, no. 3 (2001): 421–430.CrossRefGoogle Scholar
Danis, M. Southerland, L. I. Garrett, J. M. Smith, J. L. Hielema, F. Pickard, C. G. Egner, D. L. Patrick, D. M., “A Prospective Study of Advance Directives for Life-Sustaining Care,” New England Journal of Medicine 324, no. 13 (1991): 882–888; Morrison, R. S. Olson, E. Mertz, K. R. Meier, D. E., “The Inaccessibility of Advance Directives on Transfer from Ambulatory to Acute Care Settings,” JAMA 274, no. 6 (1995): 478–482.CrossRefGoogle Scholar
Teno, J. M. Stevens, M. Spernak, S. Lynn, J., “Role of Written Advance Directives in Decision Making: Insights from Qualitative and Quantitative Data,” Journal of General Internal Medicine 13, no. 7 (1998): 439–446; Teno, J. Lynn, J. Wenger, N. Phillips, R. S. Murphy, D. P. Connors, A. F. Jr. Desbiens, N. Fulkerson, W. Bellamy, P. Knaus, W. A., “Advance Directives for Seriously Ill Hospitalized Patients: Effectiveness with the Patient Self-Determination Act and the SUPPORT Intervention,” Journal of the American Geriatrics Society 45, no. 4 (1997): 500–507.CrossRefGoogle Scholar
Teno, J. M. Licks, S. Lynn, J. Wenger, N. Connors, A. F. Jr. Phillips, R. S. O'Connor, M. A. Murphy, D. P. Fulkerson, W. J. Desbiens, N. Knaus, W. A., “Do Advance Directives Provide Instructions that Direct Care?” Journal of the American Geriatrics Society 45, no. 4 (1997): 508–512.CrossRefGoogle Scholar
See Perkins, , supra note 1; Larson, E. J. Eaton, T. A., “The Limits of Advance Directives: A History and Assessment of the Patient Self-Determination Act,” Wake Forest Law Review 32, no. 2 (1997): 249–293.Google Scholar
National POLST Paradigm Initiative Task Force, “Getting Endorsed,” available at <http://www.ohsu.edu/polst/coreform.shtml> (last visited December 12, 2007).+(last+visited+December+12,+2007).>Google Scholar
Hickman, S. E. Hammes, B. J. Moss, A. H. Tolle, S. W., “Hope for the Future: Achieving the Original Intent of Advance Directives,” Hastings Center Report Special Report 35, no. 6 (2005): S26–S30.CrossRefGoogle Scholar
Meyers, J. L. Moore, C. McGrory, A. Sparr, J. Ahern, M., “Use of the Physician Orders for Life-Sustaining Treatment (POLST) Form to Honor the Wishes of Nursing Home Residents for End of Life Care: Preliminary Results of a Washington State Pilot Project,” Journal of Gerontological Nursing 30, no. 9 (2004): 37–46.CrossRefGoogle Scholar
Lee, M. A. Brummel-Smith, K. Meyer, J. Drew, N. London, M. R., “Physician Orders for Life-Sustaining Treatment (POLST): Outcomes in a PACE Program,” Journal of the American Geriatrics Society 48, no. 10 (2000): 1–7.CrossRefGoogle Scholar
Schmidt, T. A. Hickman, S. E. Tolle, S. W. Brooks, H. S., “The Physician Orders for Life-Sustaining Treatment Program: Oregon Emergency Medical Technicians Practical Experiences and Attitudes,” Journal of the American Geriatrics Society 52, no. 9 (2004): 1430–1434.CrossRefGoogle Scholar
Hickman, S. E. Tolle, S. W. Brummel-Smith, K. Carley, M. M., “Use of the Physician Orders for Life-Sustaining Treatment Program in Oregon Nursing Facilities: Beyond Resuscitation Status,” Journal of the American Geriatrics Society 52, no. 9 (2004): 1424–1429.CrossRefGoogle Scholar
National Quality Forum, A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report, 2006, at 43. Kellerman, A. Lynn, J., “Withholding Resuscitation in Prehospital Care,” Annals of Internal Medicine 144, no. 9 (2006): 692–693; Hanson, L. C. Ersek, M., “Meeting Palliative Care Needs in Post-Acute Care Settings,” JAMA 295, no. 6 (2006): 681–686; Casarett, D. Kapo, J. Caplan, A., “Appropriate Use of Artificial Nutrition and Hydration – Fundamental Principles and Recommendations,” New England Journal of Medicine 352, no. 24 (2005): 2607–2612; International Liaison Committee on Resuscitation, American Heart Association, European Resuscitation Council, “Interdisciplinary Topics,” Circulation 112, Supplement (2005): 100–108; Baumrucker, S. J., Editorial, “Physician Orders for Scope of Treatment: An Idea Whose Time Has Come,” American Journal of Hospice and Palliative Medicine 21, no. 4 (2004): 247–248.CrossRefGoogle Scholar
Sabatino, C. P., Survey of State EMS-DNR Laws and Protocols, American Bar Association, Washington D.C., June 1999.CrossRefGoogle ScholarPubMed
Fla. Stat. Ann. § 765.106 (2006).Google Scholar