This highlights the surrogate’s instrumental role in ensuring the goals of the patient are implemented. While there may be instances where the view of the surrogate and the intent of the patient differ, each state can establish safeguards to help ensure that the surrogate carries out the patient’s wishes. Such steps may require that a surrogate consult with the treating physician before authorizing a change to the patient’s POLST form, that the patient’s advance directive is reviewed, that good-faith efforts are made to act consistently with the patient’s known wishes, and that the reason for a change in the patient’s POLST is carefully documented.

Do we have legal protection? Emergency physicians are generally reassured by statutory immunity associated with a state’s laws on advance directives and surrogates. In states without a similar level of explicit immunity from criminal prosecution, civil liability, and disciplinary sanctions when POLST orders are followed in good faith, the liability climate may influence the acceptance of POLST orders.⁷ It is important to familiarize yourself with the protections in your state.

As POLST programs become more established in communities, emergency physicians are increasingly likely to care for patients with POLST forms. Better understanding of these programs may enhance the end-of-life care we provide.

References

1. POLST Legislative Guide. National POLST Paradigm Web site. Available at: http://www.polst.org/wp-content/uploads/2014/02/2014-02-20-POLST-Legislative-Guide-FINAL.pdf. Accessed June 2, 2014.
2. Moss AH, Lunney JR, Culp S, et al. Prognostic significance of the “surprise” question in cancer patients. J Palliat Med. 2010;13:837-40.
3. Moss AH, Ganjoo J, Sharma S, et al. Utility of the “surprise” question to identify dialysis patients with high mortality. Clin J Am Soc Nephrol. 2008;3:1379-84.
4. POLST Programs in Your State. National POLST Paradigm Web site. Available at: http://www.polst.org/programs-in-your-state/. Accessed June 2, 2014.
5. Schmidt TA, Zive D, Fromme EK, et al. Physician orders for life-sustaining treatment (POLST): Lessons learned from analysis of the Oregon POLST Registry. Resuscitation. 2014;85:480-5. Jesus JE, Geiderman JM, Venkat A, et al.
6. Physician orders for life-sustaining treatment and emergency medicine: Ethical considerations, legal issues, and emerging trends. Ann Emerg Med. 2014;pii:S0196-0644(14)00220-0.
7. Statutory/Regulatory Comparison of State POLST Programs, January 2013: ABA Commission on Law and Aging. National POLST Paradigm Web site. Available at: http://www.polst.org/wp-content/uploads/2013/05/Leg-Chart-POLST_3-21-13-AG.pdf. Accessed June 2, 2014.

Dr. Heine practices emergency medicine and hematology oncology in Pennsylvania.