March 30, 2020
Physician Orders for Life-Sustaining TreatmentCalifornians probably can’t do advance directives right now, but that’s likely not what they need
Last week, I blogged about legal hurdles to getting advance medical directives and powers of attorney signed under stay-at-home in California. Since then, I’ve had wonderful calls and correspondence with a number of colleagues, a few truly expert in the field. The upshots:
The more important form is likely not an advance directive or power of attorney, but a “physician order for life-sustaining treatment”, variously abbreviated POLT or POLST. POLSTs address many of the same questions, like preference about end-of-life and pain-minimizing treatment, but in the form of a medical order that follows the patient from facility to facility, rather than a primarily legal document. Patients could potentially review such forms at home, to become familiar. But the law requires a health care provider provider to actually complete the form, and physician and patient to sign it. Hospitals keep copies on hand, often printed on specially color-coded paper.
The POLST also has limitations. For example, the patient must be conscious and capable of making their own health care decisions on admission to the hospital or health care facility. But that’s largely true of patients admitted for COVID-19.
Those interested in the POLST for California should see capolst.org.
As for advance directives and powers of attorney, California’s required formalities do indeed prevent most people from getting those documents done while staying at home and keeping social distance. The ability to complete the documents electronically, but only if you notarize, where notaries must act in-person, strikes me as particularly broken. But seeing as that’s the case, it’s the opposite of helpful right now to suggest folks run out and get these forms witnessed or notarized.
In the end, generally worded advance directives actually aren’t that helpful in specific medical situations, overall. And they can complicate a POLST, with which the medical system is more familiar, by requiring a consistency analysis.
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