"COME IN" SAID THE SPIDER TO THE FLY

Do you consider yourself:

1. Medically sophisticated?
2. Legally savvy?
3. Do you get plenty of oxygen to your brain? 
4. Are you in good health?  
5. Are you on mind-altering, or judgment impairing medications?  
6. What is your age? 
7. What is your level of education?

GOOD!  Now, I want you to pretend you are a 79 year old woman, born in 1932, with an 8th grade education.  You have COPD, you've just come off a ventilator because of some breathing difficulties, your first intubation.  Three years ago when you were 76 years old, your doctor offered you a POLST, Physicians' Order of Life-Sustaining Treatment Form, in case you became too incapcitated to make your own health care decisions.  He said he would explain it to you.

You are under the influence of mind-altering drugs, as well as medications for COPD, as well as other judgment impairing medications that keep your head in a cloud, affecting your judgment and your comprehension.  You are a trusting, compliant, humble old woman.  Your doctor knows you are impaired, so he explains as best he can to you each section of the POLST, and marks the answers you give him:

1. Section A:  DNR- if no pulse or breathing, do not resuscitate.  You do not want to live as a vegetable.
2. Section B:  Yes on Limited Interventions AND FULL TREATMENT.  
3. Section C:  Yes, use antibiotics.
4. Section D:  Yes, artificial nutrition by tube

You and the doctor sign off on the form, but there is no advanced directive mentioned or included, see Page 2 of link below:

http://www.ohsu.edu/polst/programs/documents/WADec2008.pdf  

Now you have been admitted to Southwest Medical Center, come through just fine with an intubation which was successfully removed on Day 6, and you are now on oxygen tubes breathing through your nose.  You are resting, not yet ambulatory.  

Unbeknown to you, while you were sedated during the intubation, the hospital had advised your 2 or 3 of your 6 children there is a problem with your POLST.  It contains conflicting information.  The doctors need CLEAR instructions on what medical care to deliver.  The hospital states that because your POLST is unclear, they HAD to designate you a FULL CODE, DO Resuscitate.  This is a problem for them.  The hospital wants you to update the form, but you can't.  You are sedated. The hospital wants the six siblings to agree to a spokesperson for the family, so that when the ventilator is removed, and you have been off the sedation medication for a few hours, that child can speak to you and either get you to change your POLST to choices reflecting the DNR you marked in Section A, or get Power of Attorney over your medical care.  You know nothing about 3 of your children, 1 a nurse at this same hospital, who kept telling the other 3 children that you were dying, and it is time to let you go.  The hospital keeps applying pressure on your 3 of your children to come to a consensus on a spokesperson, and 'possibly to become your POA, agreed upon by an undefined "consensus" of the children. The hospital has all the paperwork and a public notary.  They won't say how many children need to agree on taking over your health care.  Is it 4 of the 6?  5 of the 6?  The hospital wants to give the family full support in getting the POLST corrected.  You have no idea of the battle and the lies going on with some of your children, perpetrated by the hospital's need, which is more important than your actual health care.  

Daily the nurses told your oldest daughter you were doing well, and were concerned about the inaccurate information 3 siblings were trying to give the other 3 siblings, because you weren't any where near to dying.  Your stats never varied, staying consistently good, and you remained stable for the duration of the intubation.
http://www.love-poems.me.uk/howitt_the_spider_and_the_fly_funny.htm

The battle over who should decide what you REALLY MEANT in your POLST, who should decide your medical care, rages on between the sibling who is a nurse, and your eldest daughter.   The nurse sibling maintains you are dying, and we need to let Mom go and not make Mom suffer.  Eldest daughter counters that Mom has never expressed she  were suffering to your eldest daughter and in fact, seemed quite happy.  Neverthless, the nurse daughter is adamant, as is the son who has been spreading the worst lies, saying Mom is on her death bed, she'll never survive what she's going through, the son with a psychology degree.   Your eldest daughter remains steadfast, and maintains the POLST is quite CLEAR: unless Mom were to be very handicapped, a vegetable, Mom wants to live, as indicated by her other choices for full treatment, even tube feeding.  So Mom is clueless about the battles, but now she's off the ventilator.  

A hospital representative comes to your ICU room in the hospital and asks if she can chat with you about your care.  Being a compliant, trusting older woman, you give her your permission.  She asks if you want a family member present, but doesn't say why.  You don't see a reason to bother family members just to chat with the nice lady, so you reply no, that's not necessary.  Your generation doesn't believe in bothering family and besides, they're busy with their families and their jobs.  The nice lady starts with some lovely chit chat, speaking softly and soothingly.  She seems like such a nice lady, and she is concerned about your care.  

After a few minutes she mentions your POLST, asks again if you want a family member present, you reply no, so she proceeds.  She says some of the information is unclear, and the hospital and the doctors just want to be really clear because they want to give you the very best care that you deserve.  You respond, "oh...that's nice."   The nice lady mentions some areas of the form she just needs a little bit more information about.  She does some explaining, asks you some questions, makes some changes on the form, and then asks if you would look it over, of course knowing you have no clue what the complex form means in reality.  She asks if you have any questions, is there anything she can do for you, and then asks you to sign the form.  It's a simple matter she assures you, and thanks you, reassures you they are there to gvie you the very best care, and just let them know if you need anything.  You ask for some pecan ice cream, and she says she will speak to your nurse about it.  She does a little more chit chat with you, and then leaves you to rest.  You're so tired now.  You've enjoyed the nice company, and are feeling good that such nice people care about your medical care.  

You don't know it, but your medical care has just been changed, legally, while you are impaired.  It now reflects consistency with DNR, not life-saving measures.  

The next time you come to the hospital, with your COPD, the hospital can now, regardless of your stats, withold life-sustaining support, legally.  You will be legally murdered...er...allowed to die.  

1984, Kool-aid, Pro-Choice, Anti-sanctity of Life = POLST Form.  POLST Form, is a legal instrument. It is an extremely flawed legal instrument, marketed as a humane and compassionate and convenient instrument for the patient, BUT:  

• Contains conflicting info 

• Contains confusing terms 

• Has undefined terms

• Has caveats, confusing caveats

• There is No disclosure that it is a legal instrument 

• There is No disclosures on ramifications to patient's health care

• "Health Care Professional" fills out the form 

• Presumes HC professional explains, in lay terms, each item 

• Presumes HC professional explains, in lay terms, impact on patient's care

• Presumes patient fully comprehends 

• Presumes every patient is medically & legally sophisticated

• Presumes patient is not mentally impaired by age, medical condition and medications, language or 

other comprehension limiting condition. 

• Can be interpreted subjectively by health care professionals

• Patient is not afforded a legal advocate  

• Once in place, POLST, undermines the medical care of a patient, And

• Usurps the rights of patients who did not fully comprehend, but weren’t aware they did not understand. 

• It undermines the sanctity of life.  

• Takes advantage of The Most Vulnerable populations: the aged, the ill, the disabled, the medically & legally unsophisticated.  

• Protects medical community, therefore it 

• Is a conflict of interest for a health care professional to administer the process of explanation & filling 

   out form as it does not protect the patient’s rights but rather those of the medical community.  

• No protections in place for the patient.

The eldest daughter is wondering how many vulnerable people are seduced into doing the POLST, and upon hospitalization, are told there is a slight problem with the form?  How many of these cases have Southwest Medical Center "updated" or "corrected?"