A little publicized law in New Jersey allows patients facing end of life care decisions to die on their own terms. The law, signed in 2011, created the POLST (Practitioner Orders for Life-Sustaining Treatments) form, which allows patients to spell out what kind treatments they are willing to accept in their final months, weeks or days. The one-page form completed by a doctor or nurse practitioner with the patient’s help is legally binding, unlike a living will or advanced directive which are often done before the onset of a terminal illness. The form accompanies a patient’s medical records and is kept at the bedside. It is used if the patient is unable to communicate. Palliative care experts are called in to meet with patients with poor prognoses, and help counsel them through the decision making process.
Barbara Figge Fox, a journalist in the Princeton area, had polar opposite experiences when dealing with end of life issues – one with her mother before the new law, and the other with a close relative just last year. Prior to the new law, there was no counseling or consultation with a palliative care practitioner. Instead of living her final days at home, surrounded by comfort and familiarity, Barbara’s mother lived her final days in a nursing home, after a rushed decision in the Intensive Care Unit between Barbara and the treating physician. That decision still haunts Barbara.
Fast forward to last year, when Barbara faced a similar circumstance with another close relative. This time, a doctor met with them over the course of a week while she was at Princeton at Plainsboro Medical Center, Fox said. “Because there was a palliative care expert at her bedside who did not tell her what to do and just asked her questions, she was able to come to the conclusion that what she wanted was not more treatment. She wanted to rest comfortably at home,” Fox said.
Despite these experiences, few people seem to be aware of the law and and have used the form, said David Barile, a palliative care physician at Princeton hospital who served on a committee formed by the New Jersey Hospital Association, which adapted the form from other states to create a version for the state. “The hardest part for the medical community is sharing information about the prognosis. We are klutzy about that. We’ll say the prognosis is poor but what does that mean?” Barile said, who counseled and signed off on Fox’s relative’s POLST form.
Barile said the discussion breaks down to four parts: The diagnosis; the prognosis of how much time is left and what will that time be like; the patient’s personal goals of care; and the treatments that can achieve these goals. One patient’s goal was to live long enough to attend her grandson’s bar mitzvah; another patient wanted to deliver a book manuscript to a publishing house, Barile said. Both achieved their goals before they died, he said.
To learn more, please read the article on NJ.com.
