“Physician Orders for Life-Sustaining Treatment”
 
“Physician Orders for Life-Sustaining Treatment”
04.02.14

Written by Ralph Rivera, IFI Lobbyist

Contact your state senator to vote NO on SB 3076.

State Senator John Mulroe (D-Chicago) has introduced SB 3076 which would amend the Illinois Department of Public Health Powers and Duties Law of the Civil Administrative Code to make the “Physician Orders For Life-Sustaining Treatment (POLST)” form the advance directive to be honored in health care facilities.

In Illinois law there are currently several advanced directives: the Living Will, Durable Powers of Attorney for Health Care, the Health Care Surrogate Act, and now POLST. Only the Durable Power of Attorney for Health Care seems to have the flexibility to adequately protect a patient’s wishes under the various unforeseen medical and health circumstances of one’s life.

POLST was created in 1991 at the Center for Ethics in Health Care at Oregon Health & Science University. Oregon permits physician-assisted suicide.  Key backers of POLST forms include foundations like the Robert Wood Johnson Foundation that have funded “right to die” organizations. That alone should indicate the real intentions behind POLST.

Anyone who deals with or will deal with the health care system should be concerned. 

Take ACTION: Click HERE to send an email or a fax to your state senator. Ask him/her to please vote against SB 3076.

Background

POLST stands for “Physician Orders for Life-Sustaining Treatment” but has less to do with “life-sustaining” and more to do with life-ending. Remember that words and changing definitions are often used deceivingly to fool people.

In Box A of the Illinois POLST form,  a patient is asked to check either “Attempt Resuscitation/CPR” or “Do Not Attempt Resuscitation/DNR” if a “patient has no pulse and is not breathing.” The POLST makes no distinction as to whether the patient is in a dying or non-dying condition. The POLST is an “actionable medical order” that is to be carried out over any objections by family or friends. It is immune from liability under state law if done in good faith. However, many patients would not know how this “actionable medical order” could affect them.   

For example, a family member could be diagnosed with a treatable cancer and good prognosis but has an allergic reaction to his first treatment and, as a result, stops breathing. If that patient checked the “Do Not Attempt Resuscitation/DNR,” CPR, which would normally be administered, could not be.  POLST makes no distinctions between terminal and non-terminal conditions. 

In Box B, the patient is given three choices. The first box is “Comfort Measures Only (Allow Natural Death).” This sounds as though the patient would receive care to keep him comfortable while dying a natural death. However, “Comfort Measures Only” do NOT include food, water, or antibiotics. Is dying by starvation and dehydration like Terri Shaivo did a natural death?  Of course not. Denying nutrition and hydration to any person causes death. Delivering fluids by minimally invasive IV therapies is generally a benefit even to the dying. 

The third option offers “Intubation and Mechanical Ventilation.” Many patients need breathing support only for a period of time after which, they can be taken off of it and live. Again, no distinction is made between terminal and non-terminal conditions. 

Box C asks if the patient wants “Artificially Administered Nutrition (Offer food by mouth, if feasible and as desired).”   The first option in Box C is “No artificial nutrition by tube.” The second is “Defined trial period of artificial nutrition by tube.” The Third option is “Long-term artificial nutrition by tube.”  While Box C has a place to add instructions, how many elderly or weak patients (or most patients for that matter) would think to do so? It is unlikely that most patients will closely analyze every nuance of the form. 

Finally, while the back side of the POLST form does state that this is “always voluntary and is for persons with advanced or serious illness or frailty,” the front side of the form does not distinguish between a person going in for a relatively simple treatment and someone seeking treatment for a serious illness. The Illinois POLST form says on the front, “Follow these orders until changed.”  This is the “actionable medical order.” 

SB 3076 would change the POLST form from requiring a physician’s signature to requiring the signature of a “practitioner.” This means that a physician’s assistant, advance nurse practitioner, or a licensed resident could sign the form after completion of one year in a program. Nurses and physician’s assistants are competent professionals, but they are not physicians.  

Note the Change in the Hippocratic Oath 

The pro-life position–which reflects the ideas embodied in the classical Hippocratic Oath of old–prohibits physicians from causing death by either acts of commission or omission. Unfortunately, we are rapidly moving away from the  classical Hippocratic Oath which committed physicians to “First do no harm.” Instead, it’s being replaced by the modern Hippocratic Oath which states in part that “If it is given me to save a life, all thanks.  But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.”

The better educated a patient is, the more protected he or she will be when completing any advance directive which may ultimately decide his or her  life outcome.  

There are a number of changes that need to be made to the Illinois POLST form. Until they are included in this bill, we urge you to contact your state senator and ask him or her to vote NO on SB 3076.


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