Panel discusses advanced directives, POLST

By | October 17, 2012

Smith, an Oconomowoc urologist and past president of the Milwaukee Guild of the Catholic Medical Association, was part of a five-member panel that discussed the POLST controversy with more than 100 people attending a seminar Thursday, Oct. 11, at St. Thomas More Church in Appleton.

“I have expressed my concerns that we may be on a track to POLST if we adopt the uniform advanced directive program of the Wisconsin Medical Society. The Wisconsin Catholic bishops said they are not interested (in the medical society program),” Smith said.

Bishop David Ricken joined the state’s other bishops on July 25 in issuing a pastoral statement warning against the use of POLST documents when making end-of-life medical decisions, saying POLST violates Catholic teachings and could lead to euthanasia.

POLST is a preset form, not requiring patient knowledge or consent, that establishes medical orders to withhold or administer treatments including food, water, CPR and life-sustaining medicines.

Established in Oregon during that state’s consideration of assisted suicide laws, POLST usage has spread to several states and made inroads in Wisconsin, particularly in the La Crosse area.

Last week’s seminar drew a cross section of Fox Valley residents including clergy, medical personnel and concerned residents.

“I came because I’m 84 years old and I wanted the information they were giving out,” said Jim Hawley of Appleton. “I want to make sure, if necessary, that my wife, Helen, controls what happens to me, period, not some doctor, nurse or anyone else making those decisions.”

Smith, who co-authored a study earlier this year by the National Catholic Bioethics Center on Health Care and the Life Sciences outlining ethical problems with POLST, said efforts are mounting to educate Catholic health care consumers as well as physicians to the dangers of POLST.

“The Catholic Medical Association is looking to put together a white paper (policy document) on this issue so we can try to inform Catholic physicians,” Smith said.

Smith said a POLST document is an “unusual and dangerous directive” requiring health care workers to enforce instructions in the POLST before calling a physician.

“It’s almost like ‘Don’t call me until it’s over,'” Smith said.

POLST is seen as a way to control medical costs and Smith said there is evidence in states where POLST is used that it held down costs in the last year of life.

But that raises questions of seeking cost savings versus maintaining the dignity of life, he said.

Fr. John Doerfler, vicar general and chancellor for the Diocese of Green Bay, said POLST doesn’t take into account “in-the-moment” decision making during a medical crisis that bases treatment on a patient’s immediate needs and not a preset list of treatments to be withheld or administered.

“We really can’t make good decisions apart from the circumstances the patient is in,” Fr. Doerfler said.

He said church officials continue to recommend the use of durable powers of attorney to keep medical decisions in the hands of patients and designated relatives or agents.

“Every human life is precious and has incredible dignity and incredible worth. We want to do all we can to preserve life unless there is a time we realize we’ve done all we can do,” said Fr. Doerfler. “We can look at the circumstances and condition of the patient and whether the treatment would either be terribly burdensome or futile. Maybe it’s time to realize we need to put things in the hands of God.”

Fr. Doerfler said the Catechism of the Catholic Church says discontinuing medical procedures considered burdensome, dangerous, extraordinary or disproportionate to the expected outcome are legitimate. But those decisions should be made by the patient or those legally empowered to make those decisions, not a physician or other medical professional.

He said that, to his knowledge, all Catholic health care facilities in the diocese have been instructed by the bishop and agreed to not use or distribute POLST forms.

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