Mental HealthBrian Andrew Tully Argues Physicians' Orders For Life-Sustaining Treatment Is Not A Good Model For End-Of-Life Care Planning
Brian Andrew Tully, Esq., an attorney specializing in elder law, argues against POLST (Physicians" Orders for Life-Sustaining Treatment). In his article "A Counterview: Objections to the POLST Paradigm," which was published in the February 2009 issue ofThe Elder Law Report, Mr. Tully states that POLST gives physicians autonomy in the decision-making process, without having to consult with the patient or the health care proxy.
"Technically, this form makes it more convenient and legal for a physician not to engage the health care proxy/surrogate in a discussion of the patient"s wishes and circumstances," Mr. Tully argues. "In the current health care climate of cost containment and stringent constraints on time spent with patients, a patient"s power and an agent"s authority can all too easily be undermined - amounting to a legalized process of exploitation."
On July 8, 2008, New York State Governor David Paterson signed MOLST (Medical Orders for Life-Sustaining Treatment) into law, which was based on the POLST paradigm model. Excellus BlueCross BlueShield, one of the largest health and long-term care insurance companies in the Northeast, was responsible for crafting MOLST. Mr. Tully calls the health care provider"s involvement "suspicious" and financially motivated.
"The goal of any business, including non-profit organizations, is to increase revenue while minimizing expenses," Mr. Tully says. "Since health care costs are highest in the last months of life, this area is ripe for cost-saving measures that are often determined by outside consultants and organizations that know the specific expenses to be trimmed."
In his article, Mr. Tully argues that right-to-die organizations such as the Euthanasia Society of America and Compassion and Choices - the latter group being a merger of Compassion in Dying and End-of-Life Choices (formerly the Hemlock Society) - could use POLST for their own agenda of physician-assisted suicides, which would reduce costs for healthcare companies.
"This background of the POLST paradigm"s supporters demonstrates their foundation in secular humanism, which presents as "ethically" acceptable many medical options that may be morally offensive to patients whose religion-based philosophy opposes concepts such as withholding ordinary care (for example, food and water)," Mr. Tully states. "The availability of these options may be coercive: because it is an offered option, these individuals may feel an obligation to minimize "burden" to others."
He also argues that POLST is redundant since every state currently has health care advance directive legislation. He cites a recent study that the use of advance directives in the U.S. has increased to 70%. "The overwhelming consensus is that the most critical aspect of improving end-of-life care is communication, not a static written checklist," he says.
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