POLST: What is it and why should you oppose it?

By Julie Grimstad

The POLST (Physician Orders for Life-Sustaining Treatment) form is a standard document that, when signed by a designated healthcare professional, dictates whether to withhold or administer certain forms of medical treatment and/or care. POLST is known by different acronyms in various states (MOST, MOLST, POST, etc.). 

A brightly colored form that is very visible in a patient's medical chart, POLST has boxes to check off indicating that a patient does or does not want cardiopulmonary resuscitation (CPR), antibiotics, nutrition and hydration, etc. Trained "facilitators"—usually not physicians—discuss treatment options with patients. After filling out the form with a patient, the facilitator presents it to be signed by a designated healthcare professional—someone who may never have seen or talked to the patient. The completed POLST form is not simply an expression of a patient’s treatment preferences; it is a set of physician's orders which must be followed.

POLST medical orders travel with the patient from one healthcare setting to the next and even home to be followed by EMT's in the event of a medical emergency. The first order in many POLST-type forms is "FIRST follow these orders, THEN contact Physician, Advanced Practice Nurse, or Physician Assistant for further orders if indicated."[i]

POLST is tilted toward non-treatment and can encourage premature withdrawal of treatment from patients who, but for the denial of treatment, would not die. Facilitators present options for treatment as if they are morally neutral, even though certain decisions may lead to euthanasia by omission. Groups that promote euthanasia and assisted suicide, such as Compassion & Choices (formed by the merger of Compassion in Dying—a Hemlock Society spin-off—and End of Life Choices), strongly endorse POLST. This is a big RED FLAG.

Judge upholds count of assisted suicide

http://www.philly.com/philly/health/20130802_Judge_upholds_count_of_assisted_suicide.html#hLRSrC4PBjvmaCti.99

POTTSVILLE, Pa. - A judge on Thursday upheld charges against a Philadelphia woman accused of helping her 93-year-old father commit suicide through a morphine overdose at his home here, where he was in hospice.

Prosecutors in Schuylkill County charged Barbara Mancini, 57, with aiding suicide. The judge refused to drop the charges after a preliminary hearing.

Pottsville police say Mancini handed Joseph Yourshaw a bottle of liquid morphine at his home in February, leading to his death four days later. The death certificate, which listed the immediate cause as "morphine toxicity" that complicated high blood pressure and heart disease, was issued in June.

Mancini, who was trained as a nurse, remains free on bail. Her lawyer could not be reached for comment Thursday evening. The local district attorney's office asked the state to prosecute the case due to a conflict of interest.

An end-of-life advocacy group called for the charges to be dropped, saying the U.S. Supreme Court allows dying patients to receive adequate pain relief, even if it hastens their death. "Attorney General [Kathleen] Kane should leave Barbara and her family alone so they can grieve over their loss," Barbara Coombs Lee, president of Denver-based Compassion and Choices, said in a statement.*

*Compassion & Choices is the former Hemlock Society.  To learn more about C & C, read:  and Theresa Schrempp, Esq.,  "Compassion & Choices is a Successor to the Hemlock Society" and Senator Jennifer Fielder on Compassion & Choices: "Beware of Vultures." 

Or, go to these links:  http://www.montanansagainstassistedsuicide.org/2012/12/compassion-choices-is-successor.html and http://www.montanansagainstassistedsuicide.org/2013/06/beware-of-vultures-senator-jennifer.html 

Texas Women Underwent Chemo After False Diagnosis

http://news.yahoo.com/texas-woman-underwent-chemo-after-false-diagnosis-132745549.html

William Holt 5 hours ago Health

A woman from Victoria, Texas, underwent several rounds of chemotherapy, only to find out that she never had cancer to begin with, reports CBS’s Houston affiliate, KHOU.

Herlinda Garcia, 54, was diagnosed with stage 4 terminal breast cancer after she had a benign tumor removed from her left breast. Through the next seven months and eight rounds of chemotherapy, she felt her body and mind deteriorating.

“Everything was swollen,” Garcia told KHOU. “I lost my eyebrows, my eyelashes. It’s really hard. I can’t explain how I felt. It’s like I was in a dream.”

Certain that her life was coming to an end, the part-time civil process worker gave away most of her belongings and wrote a bucket list.

"I just wanted to give up on everything," Garcia said.

But when she decided to seek help for her growing anxiety at Citizens Medical Center, a series of scans revealed a new reality: Garcia never had cancer.

At MD Anderson Cancer Center in Houston, a second opinion confirmed what doctors at Citizens Medical Center had discovered.

“I was happy, but at the same time, I had anger,” Garcia said. “The damage had been done.”

For her pain and suffering, a Victoria County jury awarded Garcia $367,000. Garcia said she hopes her experience will lead others to always seek a second opinion.

“I know I’m never going to feel the same because of what I went through,” she said. “It changed my life.”

The "Liverpool Care Pathway," Hospice and Palliative Care Abuse

The "Liverpool Care Pathway" (LCP)  is a system of hospice/palliative care in the UK.  In the last few years, the system has come under fire as "stealth euthanasia" in which patients are put on the LCP "without consent" and without "being allowed, food, fluids and medication."  See the BBC article set forth below: “Liverpool Care Pathway: Your experiences.”

I periodically receive similar complaints from people in the US and Canada.  Consider, for example, this letter by an elder care facility owner in Washington State where assisted suicide is legal:

"Since the [assisted suicide] act passed, we have . . . noticed that some members of the medical profession are quick to bring out the morphine to begin comfort care without considering treatment.  Sometimes they do this on their own without telling the client and/or the family member in charge of the client's care." 

http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html

Consider also, this letter published in a Montana newspaper:

“If these terrible deaths happen when aid in dying (assisted suicide and euthanasia) is not legal, what will happen if these practices are made legal? Doctors will have even more power to take away patient choice."

http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Margaret Dore, Attorney at Law
President, Choice is an Illusion, a nonprofit corporation

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"Liverpool Care Pathway: Your Experiences"

http://www.bbc.co.uk/news/health-23301360

The LCP was developed to support dying patients

 

The Liverpool Care Pathway (LCP) should be phased out, an independent review is expected to say.

The system was designed to allow terminally-ill patients to die peacefully and with dignity.

However, the LCP has come under criticism with some believe it is being used to speed up the process of dying. There have been some reports of patients being put on it without consent and not being allowed, food, fluids and medication.

Here, [three] family members of those who have been on the Liverpool Care Pathway, share their experiences of the programme. [There are two unfavorable views and one favorable view of the LCP]

Kayleigh Hollobone

Two years ago, when I was 22, I lost my 56-year-old mother to cancer.

During the six months from her diagnosis in January 2012 until her death, she was unknowingly to us put on the LCP. She was deprived of fluids and any source of nutritional supplement without even the slightest consent or conversation with me or my family.

It was only after my absolute insistence and persistence that my mother received fluids and that was after over 36 hours without any.

It scares me that people who do not have bossy and demanding families, like me and mine, to fight for them will be left or even encouraged to die via the LCP.

My mother survived another three months. We got to hear her laugh and joke again and importantly my mother got to say her goodbyes. Had the enforced LCP been allowed to continue, those few important months of time with my mother would have without a doubt been taken away from me and my family.


I can't stress how important me and my family feel about the process of the LCP. It needs to be readdressed - the memories it could have deprived me of are invaluable. She wrote me a letter that I will have forever and it will always be the most treasured item I possess.

Helen Redshaw

"The Liverpool Care Pathway aided her in a gentle and thoughtful way”

My mother passed away from cancer just three months ago. The Liverpool Care Pathway was used and I have nothing but praise for it. We had help from night nurses through the NHS Beacon program, Marie Curie and Macmillan, all of which gave exemplary care. Leaflets on the LCP were given to us and time was taken by all to fully explain why and how it would work. 

Towards the end, my mother couldn't swallow and didn't want food - this was her body getting ready to die. It was slow and peaceful, and she was my mother until about the day before when we all knew she was leaving.

There was no prolonging of life. She was ready to go and the Liverpool Care Pathway aided her in a gentle and thoughtful way. It wasn't the refusal to give her food and drink; she no longer wanted it.

She had as natural an early death as can be and I am thankful as it helped me and my family cope as we saw her slip away. This is something that should be offered and explained to patients and family and I have nothing but support for it.

William Hughes

My father Professor Robert Hughes was subjected to this technique without my or his consent. When it became clear that his cancer of the prostrate became untreatable I was asked what I wanted to do and I told them clearly that I wanted him to die with dignity.

I was assured by the staff at the hospital that would happen, that he would have died a dignified death. He didn't. He was sedated, unconscious and died within three days looking like something from Belsen concentration camp.

He was not given water or food but instead put on a driver syringe containing diamorphine, midazolam and cyclizine. The first two of those drugs would down a horse. . .

Sadly there is no going back. I didn't know that once started, it's irreversible.

No one makes this clear. This is the main part, if not for some the final part, of the LCP.

In the new scheme when that comes out, if they allow these two drugs to be continued to be used, it is euthanasia, plain and simple.

Excuse the mess!

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Choice is an Illusion

Beware of Vultures

"[I]t seems odd that the top lobby spender in Montana this year was Compassion and Choices, a 'nonprofit' group that spent $160,356 advocating for legalization of assisted suicide."

By Senator Jennifer Fielder

As we wrangled through the budget this spring, the beautiful state capitol began to feel like a big, ripe carcass with a dark cloud of vultures circling about. 

Senator Jennifer Fielder

The magnitude of money in government attracts far more folks who want to be on the receiving end than it does those who just want fair and functional government. Until that ratio improves, it may be impossible to rein in unnecessary regulation and spending. 

Special interest groups spent over $6 million dollars on lobbyists to pressure Montana legislators during the 2013 session. Seems like a lot of money, until you compare it to the billions of taxpayer dollars at stake. Does the average taxpayer stand a chance against organized forces like that?

As your Senator one of my main duties is to sort out who wants your money, or a change in a law, and why. Getting to the bottom of it takes work. It would certainly help if well-intentioned citizens would do a little more research before clamoring onto any particular bandwagons as well.

We have to be careful not to be fooled by catchy slogans, shallow campaign propaganda, biased media reports, or plays on our emotions which, too often, conceal a multitude of hidden agendas. 

For example, it seems odd that the top lobby spender in Montana this year was Compassion and Choices, a “nonprofit” group that spent $160,356 advocating for legalization of assisted suicide. The second biggest spender was MEA-MFT, the teachers and public employees union who spent $120,319 pushing for state budget increases.

I earned a reputation for asking a lot of questions. I certainly didn’t take this job to rubber stamp anything. It's my duty to determine whether a proposal relates to an essential, necessary service of fair and functional government, or if it is motivated by piles of money to be gained from ill-advised government decisions.

You see, there is so much money in government that almost everything in government is about the money. The usual tactic is to disguise a ploy as “the humane thing to do”. . . .

Some groups work very hard to provide factual information about their issue. Others stoop to the lowest of lows to invoke heart wrenching emotions, twisted half-truths, or outright lies. You really have to look carefully for all the angles.

Assisted suicide is another issue that can be highly emotional. There are deep and valid concerns on both sides of this life and death debate. But I found myself wondering, “Where does all the lobby money come from?” If it really is about a few terminally ill people who might seek help ending their suffering, why was more money spent on promoting assisted suicide than any other issue in Montana?

Could it be that convincing an ill person to end their life early will help health insurance companies save a bundle on what would have been ongoing medical treatment? How much would the government gain if it stopped paying social security, Medicare, or Medicaid on thousands of people a few months early? How much financial relief would pension systems see? Why was the proposed law to legalize assisted suicide [SB 220] written so loosely? Would vulnerable old people be encouraged to end their life unnecessarily early by those seeking financial gain? 

When considering the financial aspects of assisted suicide, it is clear that millions, maybe billions of dollars, are intertwined with the issue being marketed as “Compassion and Choices”. Beware.

Public issues are not easy, and they are not always about money. But often times they are. If we want fair and functional government, we need to look deeper than most people are willing to look.. . .

* * *
Published as Communication from Your State Senator, "Beware of Vultures," by Montana State Senator Jennifer Fielder, Sanders County Ledger, http://www.scledger.net, page 2, 6-4-13. Senator Fielder lives in Thompson Falls MT, representing Montana State Senate District 7.