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Where there’s a will, it’s not always the way

POLST forms honor specific end-of-life wishes

Q. My sister is very ill and is cared for at home by her daughter. She wants no extraordinary care. The doctor told my sister that she should have a POLST form, but she has a living will stating her wishes. What is the difference? What if they call 911? What will happen?

A. “A person really needs advance directives – a living will and a durable power of attorney for health care – as well as the Physician Orders for Life-Sustaining Treatment (POLST) form. Each one has a different function,” said Terry Furst, palliative care social worker from Olympia.

A living will addresses a person’s wishes regarding life-sustaining treatments when that person has an incurable or irreversible condition, but first responders cannot honor these directives, because they are not a doctor’s order. And the law requires medics to do all they can to save a life – including attempting resuscitation.

The POLST form, available from doctors and in hospitals, must be signed by a licensed health care provider. It is the only form that first responders are obligated to honor.

The form addresses whether to attempt resuscitation, but it can also include a person’s wishes regarding other end-of-life preferences, Furst said.

“In this culture, we feel obligated to offer CPR to patients even when we know it will be futile, putting a heavy burden on confused patients and families at a very vulnerable time,” Furst said.

CPR’s success is often overestimated by the public based on unrealistic success rates seen on fictional television shows, while the physical and emotional trauma inflicted is underrepresented.

Your sister should have a POLST form and a living will. And encourage her to complete a durable power of attorney for health care form, designating someone to make health care decisions should she be unable to speak for herself.

With direct conversations and the right documents in place, your sister’s wishes will be carried out.

Q. A friend of mine, who has a child who is dying, gets cards that say “Get well soon.” She also gets cards from people saying “God has a plan.” Why do people say insensitive things like that?

A. The insensitivity is probably not intentional. Most people are not very good at expressing words of reassurance in times of tragedy, especially concerning children.

So they often resort to bromides passed down through the generations, such as “this is God’s will” – the worst possible thing to say, even to the most religious person you know.

“They don’t care if it’s God’s will,” said Donna Haddad, a certified grief specialist from Grass Valley, Calif. “Their heart is breaking.”

People intellectualize grief to avoid the tough emotions, Haddad said. They try to make death rational – “God has a plan” – when a child’s death is the most irrational of all deaths.

As for the “get well soon” cards, it’s again likely a bad habit. When someone is sick, you send a get well card. People may assume that no one pays attention to the printed words on a card, but they do.

Instead of a preprinted card, find a blank card with a beautiful photo or painted scene on the front and use your own spare words inside.

Haddad told EndNotes: “Simply say ‘I know this must be a difficult time. My thoughts are with you. I’m here, and my heart is open if you want to talk.’ ”

One final note: To prevent insensitive expressions of grief from getting passed down, parents should include their children when writing condolence messages. They will likely send their condolences by Facebook or text someday, but the comforting words they learned from you will transcend any medium they use in the future.

Catherine Johnston, a health care professional from Olympia, and Rebecca Nappi, a Spokesman-Review features writer, welcome your questions about what to do in times of illness, dying, death and grief. Contact them through their EndNotes blog at www.spokesman.com/blogs/endnotes.


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