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Member Voice On End-of-Life Decisions: POLST Provides Peace of Mind

Note: Guest blogger Leon Kraybill, MD, CMD, is a geriatrician at Lancaster General Health and a PAMED member. He can be reached at

My father lay unresponsive on the emergency room cart. His normally smiling 94-year-old face was blank. There was no response to my voice or touch. His pulse and blood pressure were worrisome.

My physician brain instinctively realized that he was probably dying. As a son, my heart cried out against the end of life for this vibrant and compassionate man.

Earlier, he and my mother had navigated to services at their long-term care facility. He appeared to fall asleep, did not wake up, and was transported to the emergency room.

It is the phone call no child wishes to receive. I arrived to find my mother at his bedside. Her face told me that she also recognized the seriousness of the situation.

As a geriatrician, I work every day with individuals with changing health. Discussions of disease, functional change, clinical decline and end-of-life care are very common.

I routinely encourage people to consider health options, make treatment choices, and share these through discussion and advance care planning documents. It is easy to give these recommendations to others.

But now it was my father in front of me. The man who had given life to me and six siblings. A man who had given his heart and soul to family and church. A man who had survived other serious illnesses.

Of course I did not want him to die, but even more, if death was inevitable, I did not want him to endure a prolonged dying in a sterile medical environment. I knew the many possible medical treatments – the greater difficulty was deciding which things should be done.

I turned to my mother, starting my usual medical discussion of code blue, mechanical breathing and medical heroics. She listened briefly, and then said, "Oh, we discussed that several weeks ago with our doctor, and completed a paper about our wishes. The paper is over there on the counter."

They had discussed and completed a POLST document (Pennsylvania Orders for Life-Sustaining Treatment). It is one of several documents used in the advance care planning discussion to document the wishes of an individual. The POLST form is used for people with significant illness, and allows specific medical orders about resuscitation, medical interventions, antibiotics and feeding tubes.

Based on this document, I quickly confirmed with my mother that they did not want a code blue, mechanical breathing or invasive life support. They would accept medications and comfort treatment.

The document clearly established his wishes for the medical team. As a son, the document gave great comfort to our decisions, knowing we were honoring his values.

Based on his wishes, we chose supportive care, focused on comfort. If he had died, we as a family were at peace knowing that we followed his wishes.

Remarkably, he slowly improved and returned to independent living. I'm delighted to still have him in my life, but I know his wishes if we face a future similar situation.

As a geriatrician, I repeatedly see the benefits of these discussions and documents. As a son, I have experienced the relief and comfort they can provide.

Advance care planning is an ongoing discussion about life priorities and goals, an evaluation of options, a choice about how we want to live, and a sharing of that through conversation and documents.

Advance care planning was essential for my father. It is important for me at mid-life. It is appropriate for my young adult children.

The priorities are different at various stages of life, but everyone after age 18 should consider and document the appropriate portions.

As a son and physician, I recognize the value of advance care planning. There are many Internet resources available to guide discussions and documentation of your wishes.

My hospital, Lancaster General Health, has information, including a simplified advance directive form. Other resources include:

My father gave my family a great gift by having this discussion before his illness. Please give yourself and your loved ones the gift of having this discussion in the near future. It's one of the most important conversations you can have.

PAMED supports the Pennsylvania Physician Orders for Life-Sustaining Treatment (POLST) program.

After being passed as a resolution at PAMED's 2012 House of Delegates, a stakeholder group was convened with the goal of developing “a proper home for a quality POLST program, and to assess the need for legislative or regulatory initiatives to resolve the inability of EMS personnel to follow orders on a properly executed Pennsylvania POLST form.”

In 2013, the stakeholder group reached consensus that new legislation is needed to assure appropriate statewide recognition and use of POLST. And, in April 2016, as a result of hard work, steadfast commitment to the goal, and dedication to collaboration, the stakeholder group completed the draft legislation. PAMED thanks all the individuals and the organizations that dedicated their time and effort to this project. PAMED will convene a group of interested stakeholders to identify and pursue legislative sponsors.


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