Posted on 08/28/2011 11:12:55 AM PDT by wagglebee
DENVER, Colorado, AUG. 24, 2011 (Zenit.org ).- A problematic new end-of-life medical form is rapidly gaining ascendency in U.S. healthcare. It is called the "POLST" document. (In my own state of Colorado, it's called a MOST document.) The acronym stands for Physician Orders for Life-Sustaining Treatment. (MOST = "Medical Orders for Scope of Treatment;" its provisions are almost identical across states.) Click here to see an example of a standard POLST document.
The document consolidates on a single form provisions formerly dispersed over several documents: it acts as a living will specifying the scope of medical interventions a patient wishes in case of incapacitation; it makes specific provision for a do-not-resuscitate order (DNR); it has a box to check in the event a patient wishes to refuse treatment with antibiotics; and it allows a patient to designate a proxy decision maker.
Similar to other advanced directives, patients complete the POLST form when their capacities are in tact and the document becomes effective when consciousness is compromised.
But different from older-type directives, the POLST document has provision for the signature of a physician (or physician assistant). This gives the designations on the document the force of an actionable medical order.
The national trend, supported by Compassion & Choices (formerly the Hemlock Society), is to structure state laws on medical directives in accord with the POLST paradigm (as illustrated by its recent adoption by states such as California, Colorado, Hawaii, Idaho, New York, Pennsylvania, Oregon, Tennessee, Utah, Washington, West Virginia and Wisconsin).
Why is the document problematic? I will speak from first-hand knowledge of the legislation that normalized the document in Colorado. I believe my criticisms are relevant to all POLST-type laws in the U.S.
The Colorado law (signed in summer 2010) abrogated an extremely important condition on living wills going back two decades. The former law authorized adults to direct medical professionals to withhold or withdraw life-support only on the condition that they were terminally ill (or in a so-called persistent vegetative state [PVS]). So for purposes of the law the refusal was conditioned by the fact that a patient was already dying. (The PVS provision was accepted under the false assumption that it was a terminal condition.) Forty-five percent of the states in the U.S. presently impose similar statutory limitations on the removal of life-support.
The POLST-type legislation removes the condition that a patient is terminally ill or diagnosed in a PVS before a refusal order is actionable. In other words, the new law permits any adult patient to refuse any treatment at any time for any reason in the event they lack decisional capacity; and health care professionals, directed by a doctor's medical order, ordinarily would be (and are) required to carry out the order. Although the law for strategic purposes is rhetorically formulated as bearing upon end-of-lifemedical decisions, it sets forth no requirement that a patient's refusal of life-support must be limited to end-of-life conditions.
If someone refuses life-support with the specific aim (or intention) of causing his or her own death, the person is choosing suicide. Morally speaking this is no different from ingesting a lethal dose of medication, or sitting in a running car with the windows closed and a hose stretching from the tail pipe to the cabin. "Why are you doing X?" If the answer is: "To die," then the person is intending self-killing, suicide, and that's always wrong.
But isn't it the case that terminally ill patients also can direct the refusal of life-support for purposes of bringing about their deaths? It is true, the condition of terminality does rule out the possibility that patients will be motivated by suicidal intentions when taking advantage of the liberties permitted by the older-type law. But in establishing the refusal of life-support in the context of medical conditions diagnosed as "terminal," the older-type law privileged as the normative context for refusing life-support the motive "to-be-free-from-burdens-in-my-remaining-days-of-life." Suffering from a condition from which one was dying, the law granted a person the civil right to refuse procedures that prolonged the dying process.
This is not the place to rehearse the ethical argument for the legitimate removal of life-support. Suffice it to say that until recently, common ethical opinion accepted the judgment that if some treatment was futile or excessively burdensome, then a person legitimately could refuse the treatment, even if its refusal promised the hastening of death. [Note: the procedure, not the life, is judged burdensome.] One intends to be free of the burden of painful, risky, or futile treatments during one's final days of life, and one accepts that one's death may be hastened as an unintended consequence.
The POLST-type law grants adults the civil right to direct healthcare professionals to remove life-sustaining procedures when those procedures are not futile and when the burden imposed by them would be offset by a reasonable hope of recovery. It juridically extends the ordinary context for the refusal of life-support to include the motive of bringing about death. Without using the term, the new law authorizes euthanasia.
This is not the only problem with the POLST model, but it's the most serious problem that the model introduces. Other problems, such as the document's provision for the removal of food and water from patients for whom they reasonably would be judged to be ordinary/proportionate care, or the simplistic designation, "No Antibiotics," whether or not such drugs are medically indicated, already infect older type documents.
When the Colorado Catholic Conference, which I assisted, was fighting (ultimately unsuccessfully) at the state capital in Denver to amend the POLST-type legislation before passage to reintroduce the condition of terminality, we argued that the legislation as written was effectively legalizing euthanasia by omission. Some legislators believed that we were being alarmist. They thought that because physician-assisted suicide was not legal in Colorado, nor explicitly legalized by the proposed legislation, we had nothing to fear. We said we thought this was short-sighted, that groups like Compassion & Choices would find fertile soil in the law for advancing its aims. Most were unconvinced.
On August 17, 2011, Compassion & Choices (CC) launched a nation-wide public education campaign entitled "Peace at Life's End – Anywhere." The euphemism means "legal self-killing anywhere in the U.S." (The press conference was held in Denver, Colorado!) The central purpose, indeed the sole purpose of the campaign is to tell people everywhere that they can kill themselves legally anywhere in the U.S.; all they've got to do is to refuse life-support, in particular food and water. The Web site reads:
One method of peaceful dying…universally available, legal, safe, painless and suitable for a gentle parting in one's own home…is the purposeful refusal of food and fluids, in medical jargon known as voluntarily stopping eating and drinking (VSED).
"VSED," its press release stated, "is a legally recognized option for mentally competent adults who wish to end their suffering." And best of all, "it requires no special laws or regulations. VSED is legal -- for patients and their caregivers -- today, in every state."
The POLST document is not a precondition for the success of CC's campaign. Any living will that permits the removal of food and water would be adequate. But the new document sure helps.
If the POLST model is not already legally recognized in your state, five to one chance that legislation is being drafted at your state house as we speak. You might call your legislator and find out.
* * *
E. Christian Brugger is a Senior Fellow of Ethics and director of the Fellows Program at the Culture of Life Foundation , and the J. Francis Cardinal Stafford Chair of Moral Theology at St. John Vianney Theological Seminary in Denver, Colorado.
This is a very important point that is misunderstood by much of the public.
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As well it should.
By what basis should the government have the right to decide what medical treatment to force on an unwilling adult?
You gotta give the left points for adapting to cultural circumstances.
Unlike the thuggery of Mao or Stalin or Pol Pot, our leftists are committing genocide under the radar. Kill people in the womb, where each death isn’t even noticed except to the mother and a few others. Millions have died in a subtle genocide that makes the cleanliness of the national socialists seem sloppy and messy. Now millions more are slated for execution, and it’ll be a quiet affair between the physician and the patient.
If there’s one thing that the progressive do well, that’s killing their neighbors. Leave it to the American progressive to make those deaths occur without stirring up the passions of those clinging to their guns and religion.
I suspect this is similar to what happened to my grandmother a few months ago. She lives in Denver. She took her ailing husband to the hospital because he had a bad fall (as most old timers sometimes do) then signs some papers and later finds out they want to END his life (YES!). So she calls my parents up asking what to do (panicking the whole time). She apparently learned she could rescind her signature of sorts (not sure what this is called). I only heard this second hand but suspected maybe she had misinterpreted the hospital staff.
This article make me think that that in fact was not the case and that they did in fact want to end it. So later on I ask my mother how that is progressing and she stated the hospital told my grandmother she was “being selfish” for wanting to take her husband back home. Needless to say my parents were LIVID. Grandpa is 82, she is 74 I believe.
My first MIL was in the hospital dying of liver cancer and she also had complications from Rheumatoid Arthritis. She was literal moaning and screaming as the pain wrecked havoc upon her. Watching that was something that I’ll never be able to scrape from my memory.
The doctors were afraid to give her any pain meds, as it might kill her. Finally, mercifully, one did give her a dose of morphine. The pain was gone within minutes.
She was gone within an hour.
During that hour she got to say how much she loved her kids and grandkids. Then she mercifully died.
Was it murder? Was it suicide? I’ll leave that up to God. I know that in the same situation I would prefer the pain killers and drifting off to death that screaming in horrendous pain the last hours of my life in order to not offend the sensibilities of those that I don’t even know.
Germany’s 1930s version of progressives used the term (translated into English) “life unworthy of life”.
“By what basis should the government have the right to decide what medical treatment to force on an unwilling adult?”
(imo)
Some people believe that no matter how much pain you might be in at the end of your life, you have to be made to suffer until you die so that their idea of their religion is not offended.
None. But there is a whole cult here that takes the most personal end of life decision and attempts to make it into a matter for the state. Fortunately they don't have a large following.
Theres a lady with cancer in my area who was sent home from the hospital about 2 weeks ago to die
Other than medicine for pain she doesnt need life support..
But her family dont think its strange that she does not have a feeding tube
She can take in very little water and food each day..
She is being starved to death...
The nurses who come to the house keep talking about Heaven...
She is still bright and alert..
Terri Schaivo revisited..
What would you prescribe?
BTW this lady was doing Chemo treatments for a while and was responding positively to them anhd was in remission for a while..
Someone talked her into giving them up because she was so ill after them..
She was convinced she would not die without them..
She went downhill rapidly when she stopped the Chemo...
“”To die,” then the person is intending self-killing, suicide, and that’s always wrong.”
My 94 year old Dad died on August 3rd. He’d been essentially crippled and in great pain for about five years.
Dad had a living will, a Do-Not-Resuscitate and had granted health care power of attorney to my sister with specific instructions, no feeding tubes, no machines, no electric shocks. On Friday, July 30th, he had a massive heart attack. The emergency room cardiologist explained what he could do and my Dad asked, “What are the potential outcomes of operating?” The cardiologist said, “about 20% of the time the patient’s heart will stop and we’ll have to perform extreme measures to get it started again.” My Dad roused himself to say, “No operation. No extreme measures.”
There was nothing left in my Dad’s life. He couldn’t see due to macular degeneration. He couldn’t hear or taste anything. He was existing and he didn’t like it. He told me after a recent collapse, “Everything got so peaceful and warm and I didn’t hurt. If that’s death, bring it on!”
After the no-extreme measures decision was made, the Cardiologist told the family, “if he were my father in that condition, I certainly wouldn’t put him through any more.” However, the floor doctor ordered advanced medications and that started a cycle where the cardiologist had to start testing. If, during a test, were where told, his heart stopped, they’d code him and go into extreme measures. Repeatedly, the family had to stop the hospital from performing procedures. As my Dad slipped away, the floor doctor tried to code him again and I insisted no. The doctor stabbed the IV machine, shutting it off, and angrily said, “Well, then, he’ll die in 40 minutes!” Up to this point, Dad had been receiving IV fluids, but the doctor pulled out the catheter.
We looked up the living will and it said, no fluids. (I think Dad was thinking about a feeding tube when he wrote that.) Dad died three days after and I spent much of the time slipping one straw full after another of water into his mouth.
Nobody in the family would approve of euthanasia. But Dad understood people die and it was his time. He was not killing himself. He was allowing himself to die because living hurt too much. There’s a difference.
I held his hand and talked to him for most of the time he was there; mostly, he didn’t know I was there. I’m wondering when I’ll stop crying.
Food and water is NEVER "extraordinary" treatment.
At least a feeding tube
If she going to die fine
but let it be natural and not aided by starvation..
Feeding her is not going to stop the dying process if she is dying
But we are not allowed to do to a dog what these nurses are doing to a human being..
Do you take the same view of the question, "Why are you NOT doing something?"
For example, is declining a liver transplant suicide? Is declining experimental chemotherapy suicide? Is declining brain surgery suicide?
>>>Germany’s 1930s version of progressives used the term (translated into English) “life unworthy of life”.<<<
Sadly proving my point, except we’re Americans. It’s all about personal choice and individual freedom... gently and inexorably pushed in the progressive direction. Who needs the Nuremburg laws when you have genial good-looking Hollywood stars endlessly promoting the ideal of happy carefree sex at the expense of the fetus, or the craggy but friendly doctor smiling as you decide, seemingly on your own, that an amorphous “quality of life” has declined to the point of suicide?
Aldous Huxley’s dystopian future is seemingly the most precient at this point, eh? At least we’ll have orgasms worry-free, and a blue pill to keep that little train chugging along.
God help us.
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