Question: The mother of a friend of mine recently passed away. My friend told me that when her mother was being taken to the hospital, the paramedics were asking about a “POLST” form. She told me that she thought she had the form, but she couldn’t remember where it was. She knew that her mother had specifically requested that she not be resuscitated.
My friend did not have to struggle with the decision whether to hold back on resuscitative measures as her mother passed away on that trip to the hospital, but she was still quite concerned about what would have happened if she had needed the form. Can you tell me what would have happened? I am in my early seventies and in relatively good health but I have had a couple of scares. Should I have a POLST form as well?
Answer: The “POLST,” along with an “Advanced Health Care Directive,” are important legal documents in California that enable a person to direct the type of health care treatment he or she wants — or doesn’t want — to receive. Without these documents or the ability of a patient to articulate his or her wishes, a patient will be labeled “full code,” which means that all possible measures will be taken to keep the patient alive.
POLST stands for “physician orders for life sustaining treatment.” The publicly available document is a legal instrument in which the patient specifies what type of treatment is to be provided — or not. It is usually colored in bright pink so that it can be found quickly, but it is not uncommon to hear of stories like your friend’s where the document is misplaced.
The legislature has started a pilot program that would keep POLST forms in an electronic database, but that is only available at present in two counties. Although the POLST was in effect in several states, its inception in California State law 10 years ago is thanks to the work of our city’s own Lois Wolk.
In 1976, California was one of the first states to create a law that enabled an individual to give instructions to a healthcare provider to withhold treatment if that treatment would just prolong the process of dying. At the same time, the law also protected healthcare providers from liability arising from following the patient’s directions.
Although the 1976 law has changed, the fundamentals are still the same. A person can make choices about what treatment is wanted, and a person can choose someone else to act on his or her behalf. The main instrument in our law is the Advanced Health Care Directive or “power of attorney for health care.” With an Advanced Health Care Directive, a person can articulate the course of care desired and most importantly designate an agent to make decisions.
In addition to designating an agent in an Advanced Health Care Directive, a person can also designate a surrogate to make health care decisions. But the choice of a surrogate must be made personally by the patient — something that an unconscious patient is not capable of doing. In addition, the surrogate’s authority applies only during the course of the treatment or 60 days, whichever is shorter. So it is best to have your chosen designee reflected in the health care directive.
Although an Advanced Health Care Directive is typically completed with an attorney as part of an overall estate plan, the POLST form must be completed by the health care provider (i.e. physician, nurse practitioner or physician’s assistant). Because it reflects a patient’s carefully considered decisions with his or her doctor, it is given great weight. Given your past medical condition and your current ability, it would make sense now to sit down briefly with your doctor and complete the form. Should something happen, your decisions are sure to be followed, and you may avoid a lot of family stress in the event of an emergency.
Atul Gawande, author of “Being Mortal,” wrote, “You may not control life’s circumstances, but getting to be the author of your life means getting to control what you do with them.” Completing some of these simple forms can give you the ability to control what choices are made when you can’t control what’s happening around you.
Preston Morgan is a partner at Kopper, Morgan & Dietrich, a Davis law firm providing family law, estate planning and trust litigation representation. His column is published every other week in the Davis Enterprise. To pose a question to Preston Morgan, contact him at https://kopperlaw.com.
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