A CRITICAL LOOK AT THE PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT (POLST): WHAT ARE ITS WEAKNESSES?
The Physician Orders for Life-Sustaining Treatment (POLST) is a novel end of life advance planning tool that is being authorized for use in many jurisdictions. In form, the POLST is similar to medical order sets that are routinely completed by doctors in hospitals and nursing homes to specify or limit life-sustaining treatments for patients who are near the end of their lives. However, the POLST is completed by a physician before the onset of a medical crisis, and can be used by patients to control end of life medical treatment like an instruction directive or prehospital Do-Not-Resuscitate (DNR) order.
The POLST has some of the same weaknesses associated with instruction directives and DNR orders. There is a risk with the POLST that life-sustaining medical treatments will be forgone when the patient would have wanted them had he or she been able to communicate. A POLST may be incorrectly viewed by doctors as a general signal for limited treatment. There can be a lack of clarity regarding what specific procedures are covered by the POLST. It is unclear whether a physician may sign a POLST for a patient unilaterally, and whether a patient or surrogate may override the form without a physicians concurrence. The POLST has some unique weaknesses resulting from the requirement that it be transferable between treatment settings, and the fact it can co-exist with a conflicting instruction directive.
All of the research studies that have been done on the POLST have significant methodological weaknesses. It is not reasonable to conclude from these studies that the POLST is more effective than instruction directives and prehospital DNR forms in allowing patients to control their end of life medical care. While the POLST is a useful addition to the tools that patients can use to control their end of life care, people may be led to believe that this advance planning device is more useful than it really is.
Advisor:Alan Meisel, J.D.; Mark Wicclair, Ph.D.; Michael DeVita, M.D.
School:University of Pittsburgh
School Location:USA - Pennsylvania
Source Type:Master's Thesis
Date of Publication:01/16/2008