End-of-Life Care

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want…

This comprehensive approach to end-of-life decisions started in Oregon in the early 1990s and is now used voluntarily by virtually all hospices and skilled nursing homes in that state. At least 50,000 Oregonians with advanced illness are covered by orders signed by a nurse or doctor. The program has provided care consistent with a patient’s wishes to limit treatment more than 90 percent of the time and has significantly reduced unwanted — and costly — hospitalizations, presumably reducing the overall cost of care.

More on giving patients more say in the medical interventions they want.

Comments (11)

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  1. Cindy says:

    This is so important. Most people don’t foresee their own death, let alone circumstances leading to a coma. Making wishes crystal clear early and often is definitely the way to go.

  2. Kyle says:

    Are we assuming these people have the resources to carry out their wishes? I couldn’t imagine these being honored by nationalized healthcare.

  3. Robert says:

    This is true- many times it is the family that cannot let go and elects to any and all procedures to prolong life when often the patient would not choose to do so.

  4. Buster says:

    It seems to be getting better. At least now our society sees the need to plan for death. In years past, death was such a taboo that people were afraid to talk about it and hospitals held the view that life was something to be prolonged by any means possible for as long as possible.

  5. Hollie says:

    This is a great idea to keep high costing medical bills at bay once the patient is mentally gone and all that remains is the shell.

  6. Slater says:

    I agree, better communication among family members before death will give the family a peace of mind should a tragedy occur.

  7. steve says:

    Too bad the claims about death panels took this out of the ACA. If you look at the Wisconsin experience, when people talk over end of life issues ahead of time patients and their families are much happier with their outcomes. It also saves a lot of money as most people who have not planned ahead end up having everything possible done to them.


  8. Thomas says:

    Very nice point. These living wills will be crucial in the 21st century as medicine progresses and technology advances even further.

  9. Afton says:

    “The program has provided care consistent with a patient’s wishes to limit treatment more than 90 percent of the time”

    What happened the other 10% of the time?

  10. Sylvia Lynch says:

    Care at the end of life focuses on making patients comfortable. They even receive medicines and treatments to control pain and such other symptoms. Some patients prefer to die at home. Others enter a hospital or a hospice.

  11. Catherine says:

    This is brilliant!