Island Senior: Making choices for advanced care

By Peggy Sue McRae,

Journal contributor.

It can be a sobering topic but getting your advanced care planning, i.e. putting things in order for possible health emergencies and/or end-of-life care, is a kindness to your family, your loved ones, your care team, and to yourself.

Having a POLST, or Portable Orders for Life-Sustaining Treatment on file and easy to find in your home may help emergency responders give you the level of care you truly desire. This is your opportunity to make choices that will affect your level of care in possible future events where you may be unable to make these choices.

After going in for a regular check-up this week I left PeaceHealth with several documents in my basket. One is the Washington POLST. These are usually on one page of brightly colored cardstock. It is voluntary to fill this out and a medical professional must sign it. I will fill mine out, take it back to PeaceHealth, my doctor will sign it, and it will be sent back to me. These are often kept in or on a person’s refrigerator. The point is that if the EMTs come to your house and you can’t speak you want them to be able to find it.

What the POLST informs medical personnel of are your wishes regarding treatment. If you have no pulse and are not breathing do you want to be resuscitated or allow a natural death? Otherwise, when you do have a pulse and/or are breathing, what level of medical intervention do you want? Here are your choices:

Full Treatment: This choice indicates use of any effective medical means to prolong your life including intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. You could be transferred to a hospital if indicated including to intensive care.

Selective Treatment: The primary goal of this choice is to treat medical conditions while avoiding invasive measures whenever possible. This choice allows for use of medical treatment, IV fluids and medication, cardiac monitoring as indicated and use of less invasive (than intubation) means to support breathing such as CPAP, BiPAP, or high-flow oxygen. You may be transferred to the hospital but intensive care will be avoided.

Comfort-Focused Treatment: Here the main goal is to provide maximum comfort. This includes using medications to relieve pain and suffering, use of oxygen, oral suction, and manual treatment of airway obstruction as needed for comfort.

It’s easy to put this kind of thing off… indefinitely. Yet, it is worth contemplating with your doctor, your loved ones, but, most importantly with yourself. Think about what it is you really want. Put your choices down and certify them. You may be very glad you did.