POLST and DNR

While a living will or advanced directive is a document that expresses your wishes for medical care, it is NOT a medical order. It may include (and should include) a designation of a medical power of attorney who can make decisions for you – but it still requires a physicians order to carry those decisions out.

This does not generally become an issue until you have a medical condition that will require physicians orders, such as a Do Not Resuscitate order. While you can express a wish not to be resuscitated, in most states emergency responders are required to begin resuscitation in the absence of a physician’s order. This is simply because their licensure and the law determines that they do not have the breadth of medical knowledge and experience to determine if resuscitation is appropriate outside of very specific circumstances (such as not being required to do chest compressions if decomposition is advanced or the head is missing). The paramedics are not any happier about having to do this stuff on a dying patient than you are, so if it happens please don’t yell at them. They don’t have a choice.

How to avoid this: In some states including here in Oregon you can request a Physician Orders for Life-Sustaining Treatment (POLST)  if you qualify, which can work in conjunction with your advanced directives

Here is the California form, with something VERY important that relates to my last post

https://www.geripal.org/2014/09/Changes-in-California-POLST-forms.html

Note on that third page, the image shown is a physician’s order – which takes the onus of discontinuing an intervention off of the family!

Before POLST was available, and in places where it has not been implemented we have the DNR order. Both of these are medical orders from a physician, and require that the patient involved meet criteria for illness, age or end of life status.

With these orders, frequently a copy will be sent to emergency services and it will be requested that you keep a copy on hand in case a response is ever sent. Some folks hang it on the fridge or on a door or wall, others keep them in the freezer or in a file. Having quick access in an emergency situation is important. Sometimes a visitor or family member will panic and call, sometimes in a move to another place an order doesn’t get moved with the patient with very sad results.

 

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