One of my previous articles discussed the main Oregon health care directive document — the Advance Directive. However, the Advance Directive is not the same as an order not to resuscitate (DNR). What do people mean when they refer to a DNR? Some patients, when they speak of a DNR, are referring to the orders in place while a patient is hospitalized. But what about persons who are not in a hospital?
An additional step for persons with an advanced illness or who are nearing the end of life would be to execute Physician Orders for Life-Sustaining Treatment (POLST). These are specific instructions jointly arrived at by the person in consultation with their physician. The instructions detail what resuscitation and other procedures the person would and would not want done by emergency medical technicians and other health care providers.
The POLST form is a pink, two-page form (which can be posted in a conspicuous place in the person’s home, such as on the refrigerator). The POLST form is completed by a person’s physician or other health care professional, based on the patient’s wishes and executed by both the patient and the health care professional. The POLST form deals not only with cardiopulmonary resuscitation, but also other medical matters such as whether to administer antibiotics. The POLST form complements the Advance Directive, and health care professionals often encourage patients facing the end of life to execute both documents in order to have maximum effect on ensuring their wishes are honored.
An additional tool available in Oregon is the statewide POLST electronic registry. The Oregon POLST registry is an electronic record of POLST forms which is designed to provide orders to emergency medical technicians and other first responders to the home if they cannot find a posted POLST form in the home. The statewide computerized registry has been in existence for several years. Duly signed POLST forms are now generally being automatically added to the computerized registry, unless the patient opts out. All patients with Oregon POLST forms who have not done so are encouraged to submit both sides of their completed and signed form to the registry. That way, if the paramedics cannot find the POLST form, they can access the registry to find out whether a patient has one, and follow its instructions.
The POLST is not for everyone, but for persons who are facing end-of-life issues, it is often desirable, and the statewide registry will make it even more effective for those who wish to utilize that option.
Bruce Coalwell has been an attorney in Roseburg since 1981 and is a shareholder in the Roseburg law firm of Dole Coalwell, P.C.