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Life-Sustaining Document Gains Acceptance in Medical Community

Terminally ill spell out wishes on POLST form

california POLST patient life sustaining orders

Pedro Medina, 88, has a POLST order that details his care choices. Medina, who had been hospitalized with cancer, wanted to go home to be with family members, including granddaughter Maria Simmons. — Photo by Jake Stangel

En español | "Where is my pink paper?" Pedro Medina demanded as he was wheeled toward the exit of the nursing home in Davis.

He was desperate to ensure that the bright pink medical form, signed by his doctor, was with him. A nurse quickly produced the pink document. It was Medina's assurance of a peaceful death.

See also: Plan for end-of-life care.

Suffering bone cancer that was expected to take his life within weeks, the retired farm worker — with the help of his family — had expressed his end-of-life wishes in a document known as Physician Orders for Life-Sustaining Treatment (POLST). The orders meant no more hospitalization for him and certainly no medical heroics to save his life, just palliative care to keep him comfortable.

The next day, it was safely tucked into Medina's carry-on when his sons took him to his native Mexico where he wanted to spend his remaining days. Now, three years later, Medina, 88, has surprised his eight children and three dozen grandchildren by rebounding and returning to Yolo County. But that pink form remains with him — always.

Thanks to growing awareness of POLST, Medina's story is becoming a familiar one.

Three years ago, a California law took effect requiring that POLST forms voluntarily signed by patients and physicians be honored in all care settings. The law also gave immunity to providers who honor a POLST document.

Eight in 10 California nursing homes have obtained a completed POLST form from at least one resident. Two-thirds have admitted at least one person who already had a POLST, said Judy Citko, executive director of the privately funded Coalition for Compassionate Care of California (CCCC).

POLST forms allow doctors to help people with serious or progressive illnesses to specify the extent of life-sustaining measures they are willing to accept when facing death, using standard medical terms on a form that health care professionals must honor. These carry more weight within the medical community than a living will, which expresses a person's desires for care but is not a medical order.

California is one of 14 states with standardized POLST forms endorsed by the National POLST Paradigm Task Force; many more states are developing their own forms.

Next: A "quality conversation" between doctor, patient. >>

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