By Daniel Waters
An article published in the New England Journal of Medicine in November was picked up by many mainstream news services. The elderly man lived in a nursing home but was found unconscious on the street with alcohol in his system. Upon arrival, he was found to have “Do not resuscitate” tattooed across his chest with his name signed and the word “not” underlined. He had no identification, and there were no family and friends present. When his condition worsened, the questions intensified. What if the tattoo was there because he lost a bet in a poker game? What if the tattoo was the result of another night of drinking and that was never his true intention?
Communicating one’s end-of-life wishes clearly and effectively can be more complicated than one might realize. Part of this is the number of invasive life-sustaining measures now in use. Some form of AND (allow natural death) or DNR (do not resuscitate) orders are in common use. Now the POLST (physician’s order for life-sustaining treatment) or MOLST (medical order for life-sustaining treatment) are being used in more than 20 states and are being considered in others.
A core aspect of POLST is that it is portable. A DNR is a doctor’s order put in place when a patient is admitted to a hospital, but when the patient is discharged, the order, like other orders, is discontinued. But POLST follows the patient and does not need to be reinstituted at each admission.
The goal is for a conversation to take place between the primary healthcare professional and patient regarding the feasible options of treatment. The primary healthcare professional answers questions and advises the patient. The POLST that can take the shape of electronic and paper notification. Chaplains can relate stories of the bright bold color of their state’s form and how it very visibly accompanies a patient arriving at an emergency room or a direct admit.
In general, a POLST form will include options: full treatment; limited or select treatment with thorough detail; or comfort measures only. Medically administered nutrition and hydration are addressed in the document. The form will include the signature of the healthcare professional and of the patient or surrogate. A form codified by a state is honored in court, and a healthcare professional can have more confidence after these provisions.
Unfortunately, some Catholic individuals and groups operate out of the fear that POLST will compromise a patient’s care or even lead to physician-assisted suicide or euthanasia. Instead, a POLST helps to ensure a patient’s desired quality of life and consultation with their healthcare professional. In November, Pope Francis addressed European members of the World Medical Association. The Holy Father directly addressed the complexity of current treatment options. He referenced the Catechism’s desire that decisions should be made by a patient who is competent and able to discuss treatment with their physician. He cautions against abandoning the sick, particularly the most vulnerable. He states that these sensitive issues should be addressed calmly, seriously, and thoughtfully.
In the case of the patient with the DNR tattoo, the hospital ethics team was consulted. Minimal treatment was initiated that would not be irreversible in the face of uncertainty. The confirming DNR paperwork was eventually secured, and the patient died the next morning. A fluorescent-colored POLST form might not have traveled with this patient anyway, but a pocket card might have. The details provided would have benefited the patient and the medical team.
The conversation regarding care is not easy. Operating out of fear of details of care overlooks the challenge of the conversation. When we listen intently to the heart of another, the difficult conversation becomes an act of God’s love.
Daniel Waters, BCC, is spiritual care coordinator at Mercy Health in Oregon, OH.
