POLST - What About a Good Death?

                                          

           POLST (Physician Orders for Life Sustaining Treatment) has met with a great deal of success in honoring patients’ and their families’ end of life decisions. Unlike living wills and advance directives that consistently demonstrate in each and every research study that they are ineffective in honoring end of life wishes, POLST does just the opposite. 

Several research studies done using POLST

          Since Oregon was the state that first initiated the use of POLST, most of the first studies originated from there. A variety of research studies have been done using POLST with very impressive results. Over 95% of the time, patient and family end of life decisions are honored using POLST. Remember to compare this with studies done on the use of living wills that show virtually no compliance in honoring patient and family end of life decisions. 

Why does it matter if end of life decisions are honored?

            Studies have shown that most elderly people want to die where they live. This really makes sense when you think about it. They want to die where they are already comfortable, giving them a sense of security as they make the last journey of life. Elderly people do not want to be transferred to a hospital where they are poked and prodded with all sorts of invasive tests and tubes coming out of every orifice. They want to be comfortable with loved ones around them. There is such a thing as a ‘good death’ and we can provide that to elderly patients.

What is a good death?

   

            We are all going to die; this is the last stage of life, here on earth. When most of us think about death; that is, if we allow ourselves to entertain that we are not immortal and we will someday reach this stage of life, we want to be comfortable. 

Being comfortable is the mainstay of a good death. This might mean pain control, oxygen, surrounded by those you love. Most of us, and especially the elderly, do not think of dying surrounded by a bunch of machines making beeping noises, while healthcare staff continually take blood, or stick tubes in places that you would never imagine a tube would go. 

While we in healthcare can do much to prolong an elderly person’s life, we cannot necessarily give them back a quality of life. 

            Book from 1997 that began the discussion on a good death.