POLST: stands for Physician's Order for Life-Sustaining Treatment.
In some states it is called MOLST (medical orders for life-sustaining treatment) or similar names. A one page, two-sided form printed on brightly colored heavy paper, it is placed in the front of the patient's medical chart and accompanies the patient when hospitalized or discharged. It gives health care providers immediate information about what interventions should or should not be undertaken.
Generally the form has boxes to check indicating whether the patient should have CPR (cardio-pulmonary resuscitation), antibiotics, tube feeding, etc. It is signed by the patient's treating physician and by the patient or the patient's decision maker.
However, with the exception of a decision that the patient should or should not be resuscitated, there is really no need for immediate access to other orders. In fact, checking boxes about other interventions essentially gives complete authority to health care providers and circumvents further discussion of what a patient may or may not want.
Patients or their decision makers are often pressured to have a POLST form, just as they are often led to believe that they must have an advance directive. Patients and their decision makers should be aware that it is illegal to compel them to sign such documents.
Terminal Sedation: refers to the "end of life strategy" which, in England, is called the Liverpool Care Pathway. A patient is placed under continuous sedation; all food and fluids are removed; and the patient dies of dehydration.
In the U.S., terminal sedation is often called "palliative sedation" and has been defined by assisted-suicide advocates as a process in which sedation is used to render the patient unaware and unconscious, while food and fluids are withheld.
However, true palliative sedation—used to alleviate a patients' pain and suffering, such as extreme agitation, that does not respond to other interventions—is a technique in which the patient is sedated into unconsciousness but food and fluids are not withheld to cause death.
In a recent issue of the American Journal of Nursing (September 2009), other "options" were described as occurring "routinely in health care settings across the country." The article by Judith K. Schwartz* discussed legal "clinical practices that hasten dying." Those practices include:
VSED: stands for voluntarily stopping eating and drinking.
After a person, who need not be terminally ill, stops receiving any food and water, death occurs within five to twenty-one days. Schwartz explained that patients sometimes forget they have made a decision to stop all oral intake so, if they ask for food or water, "caregivers should gently remind the patient of the previously made decision to stop eating and drinking."
This type of death has been described positively in medical journals, beginning with a 1994 JAMA article, "A piece of my mind: a conversation with my mother," by Dr. David Eddy in which he told of helping his 84-year-old mother—who was not terminally ill—die in this manner.
C&C has unsuccessfully tried to require health care providers to offer VSED to all patients who have a predicted life expectancy of one year. (See: www.internationaltaskforce.org/iua44.htm#17)
Physician-Assisted Dying: stands for physician-assisted suicide.
It is the euphemism that assisted-suicide advocates use interchangeably with "aid in dying." This occurs when a doctor prescribes an intentional lethal overdose of drugs that a patient takes to commit suicide.
Oregon and Washington have transformed the crime of assisted suicide into a "medical treatment" by voter initiative. In its December 31, 2009, Baxter v. Montana decision, the Montana Supreme Court declared that assisted suicide—which the court called "aid in dying"—is part of the "legal ethos of honoring the end-of-life decisions of the terminally ill."
* It should come as no surprise that Judith K. Schwartz is a regional clinical coordinator of Compassion & Choices, listed on the organization's web site as a speaker who addresses "end-of-life care."
[http://www.internationaltaskforce.org/iua53.htm]