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Honoring Treatment Preferences Near the End of Life

The Oregon Physician Orders for Life-Sustaining Treatment (POLST) Program

  • Conference paper

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 550))

Abstract

When people speak of end-of-life care in Oregon, the first thing that comes to mind for many is the legalization of physician-assisted suicide in 1997.1 The Oregon Death with Dignity Act allows the attending physician of a terminally ill patient, under certain circumstances, to prescribe a lethal dose of medication that the patient then self-administers. The law has been used infrequently with a total of 129 people dying under the Act in the first five years of implementation. This translates to less than one in one thousand deaths in Oregon each year.2 Over the past decade, health care providers in Oregon have been working quietly in other areas to improve the care of the dying. While much work is still needed, Oregon has also had some notable successes. One of these areas relates to the ability of health care providers to systematically document and communicate a patient’s preferences to have or refuse life-sustaining treatments when the person is unable to speak for himself or herself.

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References

  1. Oregon Death with Dignity Act, Oregon Revised Statute 127:800–897.

    Google Scholar 

  2. Hedberg K, Hopkins D, Kohn M. Five years of legal assisted-suicide in Oregon. N Engl J Med 2003; 348: 961–964.

    Article  PubMed  Google Scholar 

  3. Marco CA, Schears RM. Prehospital resuscitation practices: A survey of prehospital providers, J Emerg Med 2003; 24: 101–106.

    Google Scholar 

  4. Kleinfield NR. Elderly patients whose final wishes go unsaid put many doctors in a bind. New York Times 2003;July 19:Al2.

    Google Scholar 

  5. Adams J. Prehospital do-not-resuscitate orders: A survey of policies in the United States. Prehospital Disaster Med 1993; 8: 317–322.

    PubMed  CAS  Google Scholar 

  6. Sabatino C. Survey of state EMS-DNR laws and protocols. J Law Med Ethics 1999; 27: 297–315.

    Article  PubMed  CAS  Google Scholar 

  7. Leon MD, Wilson EM. Development of a statewide protocol for the prehospital identification of DNR patients in Connecticut including new DNR regulations. Ann Emerg Med 1999; 34: 263–274.

    Article  PubMed  CAS  Google Scholar 

  8. Hickman SE. Improving communication near the end of life. Am Behav Sci 2002; 46 (2): 252–267.

    Article  Google Scholar 

  9. Hickman SE, Newman J. A decade of POLST in Oregon. Portland: The Center for Ethics in Health Care, 2001.

    Google Scholar 

  10. Tolle SW, Tilden VP. Changing end-of-life planning: the Oregon experience. J Palliat Med 2002;5(2):311317.

    Google Scholar 

  11. Dunn PM, Schmidt TA, Carley MM. Donius M. Weinstein MA, Dull VT. A method to communicate patient preferences about medically indicated life-sustaining treatment in the out-of-hospital setting. J Am Geriatr Soc 1996; 44 (7): 785–791.

    PubMed  CAS  Google Scholar 

  12. Dunn PM, Nelson CA, Tolle SW, Tilden VP. Communicating preferences for life-sustaining treatment using a physician order form. J Gen Intern Med 1997; 12 (suppl): 102.

    Article  Google Scholar 

  13. Tolle SW, Tilden VP, Nelson CA, Dunn PM. A prospective study of the efficacy of the physician order form for life-sustaining treatment. J Am Geriatr Soc 1998; 46 (9): 1097–1102.

    PubMed  CAS  Google Scholar 

  14. Lee MA, Brummel-Smith K, Meyer J, Drew N, London MR. Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program. J Am Geriatr Soc 2002; 48 (10): 1219–1225.

    Google Scholar 

  15. Tolle SW, Rosenfeld AG, Tilden VP, Park Y. Oregon’s low in-hospital death rates: what determines where people die and satisfaction with decisions on place of death? Ann Intern Med 1999; 130 (8): 681–685.

    PubMed  CAS  Google Scholar 

  16. Oregon Administrative Rule: OAR 847–35–0030 [7].

    Google Scholar 

  17. Bain JW. Data-driven policymaking (an update): using statistics to shape agendas and measure progress. In: Christopher M, ed. State Initiatives in End-of-Life Care No. 18. Kansas City: Midwest Bioethics Center, 2003.

    Google Scholar 

  18. Spann J. Implementing end-of-life treatment preferences across clinical settings. In: Christopher M, ed. State Initiatives in End-of-Life Care No. 3. Kansas City: Midwest Bioethics Center, 1999.

    Google Scholar 

  19. Field MJ, Cassel CK. Approaching death: improving care at the end of life. Washington D.C.: National Academy Press, 1997.

    Google Scholar 

  20. Center for Health Ethics & Law (West Virginia, May 1, 2003); http://www.hsc.wvu.edu/chel/index.htm.

  21. Washington Sate Department of Health, Washington, May 1, 2003; http://www.doh.wa.gov/hsga/emtp/ resuscitation.htm.

  22. Utah Department of Health, Utah, May 1, 2003; http://www.hlunix.hl.state.ut.us/licensing/.

  23. Georgia Collaborative Study Group to Improve End-of-Life Care. At a glance - Improving care at the end of life: a long term care initiative (Georgia Medical Care Foundation, Georgia, 2001 ).

    Google Scholar 

  24. Center for Ethics in Health Care May 1, 2003; Oregon: http://www.ohsu.edu/ethics/.

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© 2004 Springer Science+Business Media New York

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Schmidt, T.A., Hickman, S.E., Tolle, S.W. (2004). Honoring Treatment Preferences Near the End of Life. In: Machado, C., Shewmon, D.A. (eds) Brain Death and Disorders of Consciousness. Advances in Experimental Medicine and Biology, vol 550. Springer, Boston, MA. https://doi.org/10.1007/978-0-306-48526-8_23

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  • DOI: https://doi.org/10.1007/978-0-306-48526-8_23

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4757-0976-6

  • Online ISBN: 978-0-306-48526-8

  • eBook Packages: Springer Book Archive

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