Will EMTs Honor Your Healthcare Wishes?

Will EMTs Honor Your Healthcare Wishes?

A POLST can be instrumental when planning for a peaceful end-of-life journey.

The relief in Lucy’s voice was obvious. “The EMTs listened when we said do not resuscitate. We showed them Dad’s POLST. They made Dad comfortable. They put on an oxygen mask, but didn’t force a tube down his throat. He was spared from the physical assault of CPR, and we were spared from the trauma of watching his 91-year-old body being pummeled.”

 

EMT taking care of victim in ambulance

Photo courtesy: Thinkstock / moodboard

While a healthcare directive is important for every adult at every stage of life, having a POLST (Physician Orders for Life-Sustaining Treatment) or a Do Not Resuscitate order (DNR) signed by a doctor can make all the difference when a sick or elderly loved one is nearing the end of life—assuming a more peaceful passing is desired.

EMTs are required to do everything possible to stabilize a patient, and then transport him or her to the hospital, unless a loved one or caregiver can produce a POLST or physician-signed DNR document. Because the POLST is a signed physician’s order, the EMTs are protected from liability under the authority of the doctor’s licensure.

Not every state uses the POLST form. Some states offer an Out-of-Hospital DNR form.

A POLST form can protect both the patient and EMTs.

On August 7, EMTs initially attempted to resuscitate Linda Sandhei, a 71-year-old Maplewood, Minnesota woman suffering with Parkinson’s disease. Claiming authority as her healthcare agent, husband Tom Sandhei ordered the EMTs to stop their efforts to revive her, and he refused to allow Linda to be transported to the hospital.

EMTs honored Tom Sandhei’s request, though technically they should not have. In spite of the fact that he had no documentation to prove his authority as her healthcare agent, nor a POLST stipulating do not resuscitate, the EMTs allowed Linda to remain at the Good Samaritan care facility where she had been living. She died later that day.

An investigation of the six Maplewood EMTs ensued. No criminal charges were filed. A complainant raised the question of violating policy and standard protocol. A review of the case followed.

The differences between a healthcare directive and a POLST can be confusing. The key points are noted below:

A Healthcare Directive:

  • Should be written for anyone—regardless of age or health—starting at age 18. Having the protection of a healthcare directive is not just related to aging, but addresses accidents and sudden illness as well.
  • Explains your preferences for future medical treatment if you are ever unable to speak for yourself.
  • Legally names and authorizes your healthcare agents as those who will make decisions on your behalf.
  • Is not legally enforceable with EMTs because they are not required to honor the wishes stated in a directive.

A POLST:

  • Is intended for those with a 6-12 month life horizon—those with serious illness or the very elderly.
  • States the patient’s wishes for current treatment in the form of a doctor’s orders; it is more clinical in language.
  • Requires EMTs to follow the treatment instructions.

EMTs are placed in an untenable position when a family requests comfort care only, yet lacks the legal document in the form of a POLST to substantiate their request. As was the case in this St. Paul suburb, compassion might prevail. However, violating protocol to appease a loved one is a risk most EMTs will not, and should not, take.

In the urgency of the moment, anyone could claim to be the patient’s healthcare agent. Without legal document as verification, EMTs could agree to instructions that, in fact, violate the patient’s true wishes.

There is significant opposition to the POLST that should be considered. A POLST can be written by a healthcare provider who deems it to be beneficial to the patient— while arguably, the patient might never have voiced specific treatment preferences. Additionally, a family can work with a physician to write a POLST for a loved one with dementia, claiming to know what the patient would want. Nefarious motives can be difficult to for an unsuspecting doctor to discern.

A POLST can be an important step in preparing for a good death.

If you or a loved one has a limited life horizon remaining, speak with your doctor about the possibility of writing a POLST. If you pursue this added step to ensure the right care is delivered, post the document on the refrigerator, have a copy at the patient’s bedside, and carry a copy with you at all times.

QUESTION: Have you experienced the power of a POLST for a loved one’s end-of-life journey? Will you please join the conversation by sharing this post via social media with your comment using #POLST?

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