Author Commentary: When Medicine Goes too Far

After seeing the doctors refuse to let my grandfather go in peace, I realized that the advanced directive forms are all a matter of interpretation. Who is to say when something is “incurable” or “irreversible”. Those loaded medical terms can be debated indefinitely while someone is lying in bed suffering on the edge of death, depending on the facility policies and the doctor’s belief system. Advanced directives are really meaningless without a clearer language. Recognizing this problem, compassionate people have started a movement across the nation to have each state adopt the Physician’s Orders for Life Sustaining Treatment (POLST) for those with serious illness.  This form goes through each aspect of life sustaining treatment in clear, transparent language. Most importantly, these physician orders cross facility boundaries. California just passed a law which legalizes the POLST, effective January 1st. Here are the basic types of life sustaining treatment.

Resuscitation: Resuscitation, also known as CPR, is done in the event that a person stops breathing or the heart stops beating. The forceful pressure on the chest can lead to painful broken ribs and punctured lungs. If a person is revived, there may be resulting brain damage and the quality of life may not be the same as before he/she stopped breathing or the heart stopped beating. If a person is revived, he/she may be on a breathing machine (mechanical ventilation) with a tube down the throat. Resuscitation does prolong lives. However, one with a serious medical condition may wish to decline the option for being revived because he/she may want to avoid further pain and suffering.

Medical Interventions: A critically ill person may also wish to have comfort care only. This order will keep the medical personnel focused on keeping the person comfortable instead of focused on medical procedures that may prolong life. Pain control is the main priority with comfort care. Wound care, bowel care, and bladder control also qualify as interventions that enhance comfort. Other additional treatments can be added in order to have a tailored plan for one’s desired wishes.

Antibiotics: Antibiotics fight infections. On the other hand, antibiotics can also prolong death in a person who is terminally ill and this may also prolong suffering. Pneumonia used to be considered “old man’s best friend” for a reason. Sometimes infection is the quickest, most painless way to die. One with a serious medical condition needs to make his/her wishes very clear when it comes to treatment with antibiotics. The PLOST form will help to formulate these plans.

Artificially Administered Nutrition: Feeding tubes are very controversial near the end of life. When someone loses the ability to eat or drink, fluid and nutrients can be given by a tube that is inserted thru the nose and into the stomach (NG tube) or by a tube inserted directly through the skin into the stomach. Feeding tubes can cause ulcers and infections. Because NG tubes are very uncomfortable, agitated patients usually try to pull them out. The nutrition can be life-sustaining, but that may not be what a seriously ill patient wants. When the end of life is near, the exact wishes regarding artificially administered nutrition need to be clearly outlined and discussed by the patient, the family and health care team.

Summary: The POLST form makes your wishes known, clearly. Going through each point, this form allows for discussion amongst you, your family, and your doctor. Without this form, you will be at the mercy of the medical system which can go too far. Please see www.polst.org for more information.

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Health and Fitness, Healthcare by drlasich