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What’s POLST? Another medical decision tool . . . with big problems Print
Guest column
Thursday, Apr. 07, 2016 -- 12:00 AM
John Bohn, M.D.

Medical care decisions can be difficult, emotional, and often very confusing. And adding more forms to fill out can make it seem overwhelming. This is especially true for serious medical decisions involving end-of-life issues or other situations that may call for life- sustaining treatments.

In recent years, a new form has been heavily promoted as a "tool" to deal with such matters in hospitals, nursing homes, and clinics across the country. It is called the POLST form. POLST stands for "Physician's Orders for Life-Sustaining Treatment."

Think twice about POLST

But should you have a POLST form on file? Promotors see it as a tool to effectively translate patient wishes about life-sustaining treatment into medical orders that is easily accessed from their medical record.

At first glance it may seem fine, but you might want to think twice and hold off until you get more information and advice -- after all, it does involve life or death issues.

Fortunately, some advice is already available as several bishops, the Catholic Medical Association, The National Catholic Bioethics Center, as well as others, have all produced statements of great concern about POLST. The concerns are not simply about the POLST form itself, but about what is behind it, especially its implementation process and even the concept itself.

In short, those who oppose it feel it brings with it a long list of unacceptable risks for all patients (not just Catholics), including bad medical care, interference of doctor-patient relationships, possible abuses, and much more.

Such things can be confusing for those in health care too, including doctors! When matters like this surface they could all use some prayer and some education to help them be helpful to others, including colleagues and patients.

White Mass on April 10

Doctors and other health care professionals in the Diocese of Madison can get a bit of both this upcoming weekend. On Sunday, April 10, Bishop Robert C. Morlino will celebrate this year's "White Mass" -- a Mass that traditionally invokes God's blessing upon those called to serve in the health care professions, including physicians, physician assistants, nurses, pharmacists, and others.

The White Mass will be celebrated at 11 a.m. at St. Patrick Church, 404 E. Main St. in Madison. All those in the health care professions are especially encouraged to attend.

Presentation by Dr. Frank Smith on POLST

After Mass, all health care professionals are invited to a lunch reception, followed by a presentation by Dr. Frank Smith on POLST. Dr. Smith is a Wisconsin physician who served on the working group that recently produced a White Paper titled "The POLST paradigm and form: Facts and analysis." This document outlines the official Catholic Medical Association position on this timely topic clearly and in great detail.

In his presentation, Dr. Smith will stress that the main concerns involve the disturbing paradigm shift behind the POLST concept and its implementation process. Thus, although the POLST forms themselves are problematic and have received much criticism, physicians and patients should not be led astray into thinking that merely fixing a form will fix POLST. It won't.

Concerns about POLST

To the contrary, concerns involving POLST are much deeper and widespread, and represent a potentially dangerous new paradigm shift in how health care as a system approaches clinical decision-making for patients both in end-of-life scenarios and others where life-sustaining treatment might be employed.

A Madison priest, Fr. Pat Norris, shares the concerns of many others about POLST and summarizes one of the many concerns in his dual role as an ethicist and chaplain at St. Mary's Hospital.

He said, "Catholic conscience formation relies significantly on the virtue of prudence that allows us to apply ethical norms in the concrete. As a result, prudent and appropriate moral decisions in medicine ideally should take into account concrete, real-time circumstances.

"A POLST decision, as a medical order made in advance, often is less likely to account for real-time circumstances, thereby potentially inhibiting prudential decision making. This is one of the reasons why the bishops of Wisconsin have favored a power of attorney for health care over a POLST because it allows the patient's agent to take into account not just the patient's generalized wishes but also all of the particular circumstances before a treatment decision is made."


For further information contact Beth Tumpach, M.D., at 608-217-4254 or John Bohn, M.D., at 608- 628-7552.