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POLST stands for Pennsylvania Orders for Life Sustaining Treatment. Brown tells Central Voice, “The form is a wonderful sway for individuals to make known their wishes when it comes to life sustaining medical treatment”. Legislation strengthening the form – basically changing the form from a Medical Directive to a Medical Order – “bolsters a patient’s wishes,” Brown says.
Click PA POLST to download the form.
The bolstering for end-of-life planning may take a step forward with legislation recently introduced by state Rep. Bryan Cutler with state Rep. David S. Hickernell, serving districts in Lancaster county.
PA Senate Bill 623 and House Bill 1196 allow for a voluntary process that turns patient goals and preferences for end-of-life care into medical orders, as referred to by Brown. Essentially, the twin bills establish the means by which patients can change a Medical Directive to a Medical Order, called Pennsylvania Orders for Life-Sustaining Treatment or POLST.
“The compelling reason for support of the bills is to establish a recognized, standardized tool for documentation of individuals’ end-of-life care wishes,” Brown says.
Use of the new procedure is recommended for people in their last year of life. To activate a patient’s wishes, a doctor must authorize the form. The legislation would also allow ambulance crews to follow POLST, which they currently can’t, and give legal immunity to health care providers who follow POLST.
Dr. Joan Harrold, medical director at Hospice & Community Care, says POLST “is a proven tool to help people direct their health care to live the way they want — and avoid things that they don't want — when they are seriously ill or quite frail in the last year or so of life.”
The legislation is endorsed by the Pennsylvania Medical Society.
Dr. Leon Kraybill, chief of the geriatric division at Lancaster General Health, and Margaret Costella, general counsel for Lancaster General Hospital, helped to devvelop the legislation.
“There is a perception that these discussions are morbid,” Kraybill said, but he’s found the opposite, with people showing “satisfaction, contentment, relief” when they have their wishes documented for providers.
POLST, Kraybill said, “is a vehicle to elicit the wishes of the individual based on discussion and understanding of health condition, and a way to document and share those wishes with loved ones, medical providers, and caregivers.”
Dr. Lauren J. Van Scoy, who works in the intensive care unit at Penn State Health Milton S. Hershey Medical Center, said documents are important, but the process of communicating values and wishes that guide treatment decisions is even more vital.
“The most valuable thing you can do is talk to your family,” she said. “Talking about what you want is important to reduce their stress and burden at the end of life. It’s a gift to your family because 70 percent of end-of-life decisions are made by family members.”