Weighing In on POLST/MOLST - Physician Orders for Life-Sustaining Treatment / Medical Orders for Life-Sustaining Treatment

Given Massachusetts's well-earned reputation for excellent medical care, it is somewhat surprising that we are not among the twelve states with a full-blown POLST program. POLST is the acronym for “Physician Orders for Life-Sustaining Treatment.” This is an document for use by physicians to assure that they have thoughtful conversations with patients facing serious illness. The document gives patients a strong voice in determining their care.

   In an April, 2011 report (In Brief 189) AARP outlines the evolution of state POLST programs and provides useful information for states creating such programs or refining existing efforts. AARP describes the program as “...a promising program to elicit and honor the treatment goals of people with advanced progressive illness or frailty.”

   Hopefully Massachusetts will soon join the list of POLST pioneers. A state legislature mandated pilot program in Worcester, called MOLST (Medical Orders for....) was completed earlier this year. And the recently released Massachusetts Expert Panel on End-of-Life Care (March, 2011) included a recommendation that “[A] full statewide implementation of MOLST should be achieved no later than January 1, 2014.”

The will is present. All that is needed is the money to implement the program.

 

Should Massachusetts residents want the legislature to fund this effort? The answer is unequivocally yes, if, when we are seriously ill, we want the following:

 

• For our doctor to sketch out transparently all options for medical treatment.
• To exercise our right to determine procedures we want or do not want. Absent our explicit statements, doctors are obligated to "do everything," even if it the procedure or outcome is not one we would have chosen.
   
• To relieve our health care agent from the burden of guessing what care we would want.
   
• To have the opportunity to think about and make decisions about such procedures, should we need them, as dialysis, feeding tubes, resuscitation when the heart stops or breathing apparatus is needed. Chances are, if there is a need there wouldn’t be much time, if any, to make calm and thoughtful decisions.
   
• To have one document which efficiently follows us from one medical facility to another, which we can revise periodically, which is our independent and thoughtful voice.

MOLST will serve us well. It is well worth the Commonwealth's effort and monies.

 

Herman J. Blumberg (Rabbi)
Member, The Community Ethics Committee,
Division of Medical Ethics, Harvard Medical School

Boston, MA