For PRWeb’s pdf version of the Press Release, click here. The public comments described in the release are available in a five minute video, the text of the video, and full written comments with citations.
Summary: Not Dead Yet President and CEO Diane Coleman has submitted video and written public comments to the Institute of Medicine’s Committee on Approaching Death for its July 22-23 meeting being held in Houston, Texas. The public comments raise concerns about the implementation of Physician Orders for Life-Sustaining Treatment (POLST).
Houston, TX (PRWEB) July 23, 2013
Not Dead Yet President and CEO Diane Coleman has submitted video and written public comments to the Institute of Medicine’s (IOM) Committee on Approaching Death for its July 22-23 meeting being held at the Texas Children’s Hospital in Houston. The public comments raise concerns about the implementation of Physician Orders for Life-Sustaining Treatment (POLST). Not Dead Yet has twice previously submitted comments to the Committee, previously called the Committee on Transforming End-of-Life Care.
According to the IOM website, “The IOM Committee on Approaching Death: Addressing Key End of Life Issues will hold its third meeting on July 22 and 23, 2013 in Houston, Texas. There will be a public session on July 22 featuring panel sessions on ethics and spirituality. The public session on July 23 will focus on empirical and legal issues surrounding POLST (Physician Orders for Life-Sustaining Treatment).”
Public comments are limited to approximately five minutes, so Coleman has submitted a video focusing on two of the concerns raised in her longer written comments. The video comments address the dangerous and inappropriate use of POLST with people who are disabled but not terminally ill, and the bias against life-sustaining technologies conveyed in the way the POLST forms are presented by health care providers.
In her spoken comments, Coleman informed the Committee of a recent article in the Pew Trusts’ Stateline about POLST (New End-of-Life Measure Quietly Sweeps the Nation, June 20, 2013) which quoted her and reflected her concerns as follows:
“’How do we know the POLST medical order actually reflects the desires of the individual?’ [We worry] that depending on how POLSTs are presented, they can make life-sustaining treatments—such as the use of feeding tubes—seem unbearable, even though many disabled people are able to live full lives because of them.”
In her more extensive written comments, Coleman called attention to documented evidence of problems from various states that have implemented POLST, including a Delaware state order discontinuing the use of POLST, and a February 2013 report from Disability Rights California entitled, The Deadly Failure of a Hospital to Follow a Patient’s Decisions About his Medical Care.
Coleman also addressed POLST provisions contained in a new federal bill called the “Personalize Your Care Act” that was introduced on March 14, 2013, by Representative Earl Blumenauer (D-Oregon):
“[The bill] would provide Medicare funding for physicians to have a conversation with their patients about “end-of-life care.” If done well, we agree that such a conversation can be a good thing, and I object to the ‘death panel’ accusations that obstructed rational discussion of such a provision in the Affordable Care Act.
“But there’s another section of the new bill, H.R. 1173, that would provide grants to promote POLST across the country. If we can conclude anything from the current level of information we have about how POLST is being implemented in the states that have it, it’s that many questions remain unanswered, strong reasons for concern exist, and federal funding to promote POLST is premature. The POLST provisions of H.R. 1173 should be amended to fund independent research to answer the serious questions and concerns that many have raised. That’s what the Institute of Medicine and this Committee should support.”
What excellent comments.
Looking in from the outside as an elderly Medicare eligible citizen who experienced the trauma of a unilateral and covert DNR in the chart of my late husband, I am, of course, suspicious of ALL advanced directives because they can be and are abused with apparent impunity under existing unenforced laws when fiscal futility is at stake for the hospitals and physicians.
Existing Medicare Reimbursement Protocols so often mean that physicians/hospitals have to EAT the costs of errors, mistakes, and non-beneficial over treatments and the complications thereof that are not reimbursed by Medicare and the private insurers. It is not surprising that the hospitals/physicians rationalize that these “charity” patients are “better off dead” and inappropriately extrapolate DNR Code Status into the medical/hospital charts of the elderly disabled to limit life-extending and life-saving treatments that will NOT be reimbursed.
I believe the main thrust or goal of the any directive encouraged by the state, to include the POLST, is to save money for Medicare and the private insurers who provide Medicare benefits or supplement Medicare benefits under private contracts —at a profit, of course.
The POLST does try to implement the public policy of the 1991 PSDA wherein elderly/disabled and all patients are legally allowed to shorten their lives (to shorten suffering) by refusing life-extending treatments when hospitalized and transitioning to Hospice and Palliative Care, even as these life-extending treatments are NOT determined to be medically futile under existing hospital policy and/or state law.
I see that Dr. Thaddeos Mason Pope, Medical Futility Blog, and a leading expert on Medical Futility and the Law, etc.. has indicated in a recent article that there was a “Dangerous Catholic Attack On POLST” for the same reasons that Diane Coleman points out in her comments to the Committee.
Apparently, the Catholic Medical Center (CMA) was very upset that POLST (in practice) is not limited to patients with a terminal illness — and that procedures involving informed consent for the POLST cannot overcome the “influence” of other parties on the patient in the formulation of the POLST.
Wouldn’t the Power of Attorney (POA) of a surrogate (when the patient is not competent} be sufficient in most instances and isn’t it better and safer for the patient (or the surrogate) to make these life and death decisions when it is pertinent, and not before! –especially when one of the main goals of advanced directives pushed by the State is to shorten life and to prevent terminal patients (6 moths or 12 months?) from dying in expensive ICUs and CCUs at great expense to Medicare and the private insurers.
The Catholics have protested the “growing” millions of abortions performed since abortion was legalized and I’m sure that they have a special fear that millions of elderly/disabled will have their lives shortened without their informed consent, as well, if the culture of death is nourished by POLSTS that can be misused and abused for fiscal expediency.
The New York Times recently (today) pointed out in an Article that there is a novel and new way of getting the elderly/disabled and seriously ill to talk about end-of-life choices in view of reality that the goals of “advanced directives” envisioned by the 1991 Patient Self Determination Act to promote these talks have not been attained.
Apparently, there has been a pilot program in California that pays Residents to talk to and interview old sick and/or disabled patients to help them vocalize the care that they want and do not want at the end of life — which in recorded by the means of a POLST document, of course.
But, of course, all of the DANGERS of POLST as pointed out by NDY CEO Diane Colman, and the Catholic organizations and other Disability Rights Organizations are ignored by the New York Times who likes to think of itself as a “policy maker.”