By Susan Nelson, MD
While many Americans may believe death comes suddenly and at the end of a long and productive life, that may not always be the case. For approximately 80 percent of the population, death comes after several weeks, or even several years, of progressive illness and debility.
Many years ago, patients had limited options when it came to the selection of treatments at the end of life. Today, in some cases, medical advancements have made it possible for doctors to significantly extend patients’ lives, but while some patients could benefit from those advancements, they may not be ideal for everybody.
Numerous studies have shown that patients and families who discuss advanced care planning may receive a higher quality of patient-centered medical care. Advance care planning includes documents such as the advance directive, also known as a ‘living will,’ and the health care power of attorney.
A living will is typically written well in advance of any known illness and describes the type of care a patient wants if something occurs, particularly scenarios in which the patient does not wish to receive aggressive medical care. Unfortunately, less than 25 percent of Americans have this level of planning, and even with an advance directive in place, the document requires interpretation and a physician’s order before it can be implemented.
The health care power of attorney document identifies the person who makes health care decisions if the patient becomes unable to do so, and requires the patient to state the kinds of decisions this person would make. If a health care power of attorney is unavailable, the state stipulates who would make those decisions.
Here in Louisiana, residents have another document available to them that helps to ensure their end-of-life care wishes are recorded and honored.
Created with input from health care and legal professionals across the state and approved in 2010 by the Louisiana Legislature, the Louisiana Physician Orders for Scope of Treatment (LaPOST) document is a best-practice model for patients with life-limiting or irreversible conditions to state their preferences for end-of-life treatment in a physician’s order. The document conforms to the recommendations of the National POLST Paradigm Task Force and program.
The LaPOST document, unlike a living will or health care power of attorney, is designed specifically for patients with seriously advanced illnesses and lists some of the medical treatments they would or would not want. It is completely voluntary and is biased neither for nor against treatment. Once completed, it becomes a binding medical document and can be used independently from a living will or to make a living will operational. In addition, the LaPOST document can be modified or revoked at any time based on new information or changes in a patient’s condition or treatment preferences.
Studies show that for patients who use POLST documents, treatment preferences are respected 98 percent of the time, and no one received unwanted CPR, intubation, intensive care or feeding tubes. As a result, POLST has helped bridge the gap between the treatments patients want and those they receive.
The LaPOST document improves communication between patients and doctors by providing the mechanism for those with seriously advanced illnesses to express their preferences about medical care, and because the document travels with them across health care settings, it ensures that those wishes are honored, no matter where they are.
LaPOST gives patients greater control in deciding the point at which curative treatment is no longer attempted, and focus then shifts to comfort and symptom management. This is why it is important for health care providers to be willing to discuss advance care planning by educating their patients and their families about the types of care available, who provides it, who pays for it and other related issues. Caregivers and patients with seriously advanced illnesses and their families need to be prepared to discuss the patient’s personal goals, values and religious or cultural beliefs that affect decisions about end-of-life care.
And those discussions about end-of-life care wishes are an integral part of the LaPOST document – it requires patients and caregivers to have real conversations about treatment options for end-of-life care. These can be difficult conversations to have, but by discussing treatment options and personal goals, values and beliefs, patients can make their final days easier on themselves and their loved ones.