Editorial: End-of-life treatment document a good idea

Much of the angst and anger triggered by a California nursing home worker’s decision not to give CPR to an 87-year-old woman could have been avoided had she and her family prepared a document that clearly stated she did not want such emergency treatment.

A bill just passed by the state House of Representatives would clarify Washington law covering similar situations, and should pass.

Do-not-resuscitate orders or the like are increasingly common as sophisticated medical technology allows health care providers to extend patients’ lives far beyond where they might want. Without guidance to the contrary, the ventilators pump on, the intravenous feeding continues and the heart monitors peep in time to a feeble pulse.

Because they had nothing from the elderly patient or her family to go on, the workers at Glenwood Gardens defaulted to the institution’s policy to not perform CPR, presumably one known to all when she moved in. The family has defended the nursing home’s decision.

Coincidentally, bills before the Washington Legislature would clarify who would be protected from litigation if treatment is denied patients who complete a Physician Orders for Life Sustaining Treatment form before circumstances demand quick decisions about the decree of care that will be provided.

The form, just two pages, specifies what level of care a patient wants in a medical emergency, from full treatment to comfort measures only, preferably without transfer to a hospital. The pages are bright green, and meant to be with the patient at all times. Emergency medical technicians are trained to look for them on refrigerator doors.

If not readily available, the POLST does not apply.

Now, only EMTs are protected from lawsuits if they comply with POLST provisions. If doctors or other providers obey the terms, they are still exposed to lawsuits from unhappy family members.

Absent a POLST, doctors fearful of being sued assume they are to take whatever measures are necessary to save the patient.

The result is potential situations in which EMTs bound by patient wishes may withhold care during transport to the hospital. But, once there, doctors who have no immunity start treatment even though the prognosis has significantly deteriorated.

House Bill 1000, passed by the House on Monday, would extend immunity to all providers who heed the POLST. The companion Senate bill is before the Rules Committee.

Concerns regarding the legislation have focused on the role of surrogates, and whether their decisions might conflict with those the patient might make if they were able, or made earlier when they created an advanced directive regarding their care. But the POLST must be signed by the patient’s doctor, who would certainly know more about their wishes than an emergency room doctor seeing the patient for the first time.

Washington voters, in authorizing lethal injections for terminal patients in 2008, showed they want patients given the widest possible leeway controlling their own care. Passage of HB 1000 and Senate Bill 5562 would show the same respect for personal dignity.