My View: Wishes Can Become Comforting Mandates for Patients
Tallahassee Democrat, April 11, 2014
By Marshall B. Kapp and Ken Brummel-Smith
Patients and their families confront many important medical decisions over a lifetime. None are more complex and emotion-laden, however, than choices about the initiation, continuation, withholding or withdrawal of aggressive medical intervention when illness is critical and unlikely to be reversed.
In those situations, the patient's personal values and wishes should be respected and determine the course of medical action. Sadly, sometimes such respect does not occur, and patients — especially those no longer able to express their present preferences — are subjected to intrusive, burdensome and unwanted medical interventions.
An effective mechanism for correcting that problem exists: the Physician Order for Life-Sustaining Treatment (POLST). However, its use can become sufficiently widespread only if citizens concerned about patient self-determination near the end of life educate and prevail upon their public policymakers to endorse it.
The POLST is a document that permits a willing patient (or the patient's surrogate) to convert medical treatment wishes into medical orders written by the patient's physician, instructing other health-care providers such as members of an emergency medical squad about that patient's future care. Because health-care providers routinely follow physician orders, this instrument is likely to receive more respect than patient wishes expressed in other ways, such as living wills.
A number of other states have already codified the POLST option in their statutes and/or regulations. If Florida truly values the principle of patient self-determination, especially for the most vulnerable medical population, it needs to join those states enabling POLSTs to be written and respected.
For the past several years, the Florida State University Center for Innovative Collaboration in Medicine and Law has acted as coordinator of a state POLST effort involving a large group of professionals in health care, human services, religion and law who are committed to protecting and promoting the rights of patients approaching the end of life.
Wednesday is National Healthcare Decisions Day.
The time has come for more Florida residents to educate themselves and others, including those who represent them in the public policy arena, about the Florida POLST initiative (http://med.fsu.edu/medlaw) and to advocate for its adoption within Florida law as a significant marker in the development of more ethical and humane care.
Marshall Kapp (firstname.lastname@example.org) is director of the Florida State University Center for Innovative Collaboration in Medicine and Law. Ken Brummel-Smith is the Charlotte Edwards Maguire, M.D., Professor and chair of the Department of Geriatrics, FSU College of Medicine. He also is past president of the American Geriatrics Society.