In the midst of our current COVID-19 pandemic crisis, the importance of knowing people’s wishes about their medical care is even more important.
There has been a push to make sure we are planning ahead for those people who have serious illness about what kind of medical care they want if they were to become ill with COVID-19, ie whether they want to go to the hospital or not and level of aggressiveness of care (resuscitation status and wishes about intubation).
A significant portion of patients would rather stay home than go to the hospital, and would want to avoid invasive measures. The start of determining that is a conversation about their wishes.
What are Advanced Directives?
Advanced Directives are legal documents that allows a person to share their wishes with your health care team if you can’t speak for yourself. An Oregon advanced directive allows someone to:
- Identify the person they want the health care team to work with in making decisions about their medical care (known as a “surrogate”); and
- Generally say what kinds of medical treatment they would or would not want.
- Health Decisions, Advanced Directive Website
- Advanced Directive Form
- Oregon Healthcare Representative Form
- Prepare for Your Care
What is a Physician’s Orders for Life-Sustaining Treatment (POLST)?
In Oregon, people who have made a decision to limit their medical interventions (don’t want CPR, don’t want a ventilator or ICU care) have the best chance of having their wishes honored if they have their doctor fill out a POLST (Physician Orders for Life-Sustaining Treatment).
- It’s a legal doctor’s order, documenting a conversation between a provider and the patient or legal guardian, that lets the ambulance or ER doctor do what the patient wants in an emergency.
- POLST website
- Oregon POLST form sample
What is the difference between Advanced Directives and POLST?
|ADVANCED DIRECTIVES: LEGAL FORM||POLST: MEDICAL ORDER|
|For healthy people 18 and older.||For people with serious illness or who are older and frail and may or may not want all treatment.|
|It is not a medical order and it cannot be followed in an emergency.||It is not a medical order and it cannot be followed in an emergency.|
|You give basic instructions about the care you would like in the future. You choose someone to make medical decisions for you, if you are not able to speak for yourself.||You state what treatments you want and do not want. Emergency and other medical staff must follow these instructions.|
|You can fill it out on your own.||You fill it out with your doctor or nurse practitioner.|
|You can change it at any time on your own.||You and your doctor can change your POLST at any time.|
|It is up to you to have a copy added to your medical record.||If you choose, it may be registered with the Oregon POLST Registry. This means medical staff can quickly access your POLST order in an emergency.|
POLST and COVID-19: If you get sick, do your orders match your wishes?
- The video reviews the POLST and assures it reflects what people who have one thinks it should.
- Assist people who already have a POLST in reviewing their form,
- Clarify what the orders mean in the context of the COVID-19,
- Verify that the orders still reflect their wishes for care and treatment,
- Encourage conversation with their families about their wishes, and
- Assist those whose forms do not align with their wishes in getting their form changed or voided.