December 6, 2017
Recently, the Minnesota Medical Association (MMA) released a new version of its POLST (Provider Orders for Life-Sustaining Treatment) form, and the question was raised whether it addressed our objections to its use as outlined in the Minnesota Catholic Conference statement “Stewards of the Gift of Life.” In short, the changes to the form do not address our core concerns with the POLST paradigm. There are better ways to implement advance-care planning consistent with Catholic medical ethics that avoid the limitations of POLST, which presents different care options as ethically neutral, when the morality of those decisions can differ significantly depending on the circumstances.
We understand why providers may be inclined to utilize POLST forms. The structure of healthcare delivery has changed dramatically in recent years, and POLST forms attempt to ensure a measure of continuity in a system in which multiple healthcare professionals may be responsible for a patient’s care. Similarly, advances in medical technology have greatly enhanced our ability to extend life, even in advanced illness.
Catholic moral teaching requires the provision of ordinary care to preserve the gift of life. It also supports allowing natural death to occur rather than using interventions that offer no reasonable benefit or cause excessive burdens. But these decisions must be made in actual circumstances, and the anticipated decisions that are the very nature of POLST can too easily preclude the necessary assessment of the patient’s concrete situation. We believe that informed consent is essential, which results from conversations between the provider and the patient (or with the patient’s designated health care agent for those who cannot speak for themselves) regarding the actual current situation.
We recommend the Minnesota Catholic Health Care Directive as a meaningful alternative to POLST forms. It prioritizes the appointment of a health care agent who can speak for a patient in the moment. It also permits some general guidance for decision-makers, rooted in Catholic teaching regarding the use of ordinary and extraordinary means to extend life, without compromising necessary medical judgments in possible future circumstances.
Many healthcare providers and assisted living centers have adopted POLST forms, and some use POLST forms as part of the intake process. We stress that a patient is not required to complete a POLST form, and that patients retain the right to change their advance care plans at any time. In the ongoing work of improving the care we provide to those approaching death, each patient and family deserves our real-time presence and consideration. While we cannot, ultimately, prevent death, we can make the process of dying as sacred and dignified as possible.