The following comes from an article written by Camille Giglio of California Life Advocates and sent to Cal Catholic on Nov. 9.
In 2008 the California legislature passed AB 3000, Health Care Decisions: Life Sustaining Treatment by then Assemblywoman and now state Senator, Lois Wolk,(D).
That bill was co-sponsored by (formerly named) Catholic Health Care West (now Dignity Health) and the Coalition for Compassionate Care of California
Amendments to that bill succeeded in preventing the Polst form (Polst stands for Physicians Ordering Life Sustaining Treatment) from being authorized by the state but did authorize its sponsor, Coalition for Compassionate Care of California – CCCC, – full access to aggressive promotion of the form around the state. And, indeed it has been tremendously successful in obtaining acceptance and promotion from health groups, Hospice, religious groups, community organizations, the media, the film industry and even within some pro-life groups….
One newspaper reporter, using her position as the medical reporter to sell the Polst to the public has phrased it this way: “We all believe in natural child birth, why not natural death?”
The only problem with that is the Polst form does not bring about a natural death. It is a planned death, supported with legal force. The Polst is a tool for the CCCC to initiate its strongly held belief that human life has a utilitarian purpose and when that purpose, judged by the elitists is no longer useful, that that life costs the state too much money.
I will provide some examples:
I was recently sitting off in a secluded corner of a surgery waiting room in a Kaiser hospital. I happened to notice a 40-ish aged man approach the surgery sign-in counter, but paid little attention to him. Suddenly he was standing before me asking me to please be a witness to his “form.” He said, that he couldn’t have his knee replacement surgery that day if the form wasn’t signed and witnessed. He had to have the surgery that day he said with more than a little anxiety in his voice.
It was a Polst form. I asked him if he knew what he was signing? he said, yes, but it was just a knee replacement surgery, he wasn’t going to die or anything. Just please witness this so “I can get the surgery.”
It only occurred to me later that I should have insisted that he ask the receptionist at the desk why he had to sign this in order to have his surgery and why hadn’t he been told about it before hand? This is now, undoubtedly, a part of his permanent record, but will he even recall that he filled it out?
Polst is similar to a DNR – Do not resuscitate, with the added measure of being a legally binding document that a doctor, a hospice, an ambulance team, a community clinic, must follow.
The form is one-page printed on ultra pink card stock to make it quickly identifiable to medical personnel and follows the patient from hospital to long-term care facility/hospice.
Line A has two check boxes; yes for CPR (cardio-pulmonary resuscitation) or no for CPR which is portrayed as “allow natural death.”
Line B – Medical Interventions: has 3 check boxes indicating
1) Full treatment which mandates the full resuscitative treatment and follow-up.
2)Limited Additional Interventions, i.e. comfort measures only, CPR, and IV fluids. Also a secondary box which says Transfer to hospital only if comfort needs cannot be met in current location.
3) Comfort Measures Only administered at scene.
Line C – Artificially Administered Nutrition. 3 check off boxes;
- No artificial means of nutrition, including feeding tubes (definition: starvation and dehydration)
- Trial period of artificial nutrition, including feeding tubes. (food and water, if supplied through a tube is now considered artificial means and, therefore, removable)
- Long-term artificial nutrition, including feeding tubes.
That’s all there is. A second page is devoted to Directions for health Care Provider.
Which states, in part:
- The Polst form is voluntary.
(It wasn’t exactly voluntary to the surgery patient at Kaiser.)
- It provides immunity to those who comply in good faith. (Protecting the medical personnel from lawsuits of criminal charges just like with abortion)
(Think about the elderly woman in the residential facility in Garden Grove. CA who collapsed and for whom the care provider refused to call for an ambulance or administer CPR? Her life could have been saved if either CPR was immediately begun or the ambulance came quickly. She did not die a natural death she died from suffocation.)
- It doesn’t replace an Advance Directive.
(That’s right, it is for the here and immediate now. If you are in a restaurant or in a rehab facility and you choke on a piece of bread or meat and the EMT people ask if the lady has checked off A on the Polst form, it’s no CPR for you. The EMTs already have an understanding that it’s no use speeding to attend that person. They can take their time and just watch the person once they get there. Or, as the reporter, Lisa Krieger said with a shrug of her shoulders when asked: “well, the ambulance can just transport her to the morgue.”)
How can there be any value to an Advance Directive, which is planning for the future? Can the Polst say no CPR, but the Advanced Directive say yes to CPR?
What if you fall and break a hip, but you’ve signed a form that says comfort care only?
Also California now has a law that says any health care personnel, nurse practitioner, doctor, midwife, or family member etc., can fill out and sign the form for the patient. The exact wording is: “A legally recognized decision-maker (the janitor?) may request to modify the orders, in collaboration with the physician, based on the known desires of the individual, or, if unknown, the individual’s best interest?”
Comfort care can often mean larger and larger doses of morphine until the patient has lost all touch with reality and desire for food or water.
No artificially provided water or nutrition. That’s starvation and dehydration.
Finally the form says that anyone can revoke the Polst form at any time. However, if you don’t know that your doctor or family member has signed a Polst, or you are already semi-conscious from too much morphine will you be sharp enough to demand that they tear up that form? www.caPOLST.org.
On one occasion my husband as designated decision-maker, was called in for a consult with the doctor, the seriously ill family member and his ill wife. The couple had no children. The doctor stated that the hospital had done all it could for the man and he was going to be moved to a long-term care facility. While he was speaking a woman quietly entered the room claiming to be from the discharge office. Before our eyes the doctor seemed to disappear into thin air and the woman – not a nurse – began to ask what medical services the husband would wish to have provided to him in this new facility. She had a soft and soothing voice, making it seem like it was her heartfelt goal to meet every wish and desire that the patient had.
As she spoke I began to realize that she was selling the patient on signing the Polst form. I charged her with trying to get them to sign the form. She looked all sad and disappointed and declared that she just didn’t know what I was talking about. She had never heard of this form. This occurred in a Catholic hospital in Fresno which, it now turns out, is affiliated with Compassionate Care.
Later, I googled her name and found that she was very active throughout the Centrarl Valley in speaking for Compassionate Care and promoting the Polst form.
Which brings me to my final example. A well-recognized pro-life Catholic parish recently held an end-of-life planning seminar for parishioners. The title of the seminar was “Let’s Have that Conversation.” One of the speakers, representing palliative care treatment was Vitas Hospice. Vitas is affiliated with, amongst other groups, Coalition for Compassionate Care of California. Palliative Care is often also referred to as “The Third Way” or Stealth Euthanasia. WWW.vitas.com/default.aspx?tabid=81376….
I wonder if the author has ever read the Ethical and Religious Directives for Catholic Health Care. The section on issues related to the end of life, allow, when there is no more physicians can do for a patient’s survival, to allow natural death. It even stipulates that financial considerations can be taken into account and that comfort measures are moral when a patient is dying. Every situation is different but a general sweeping condemnation of every attempt to “allow natural death” is not the way.
Dear Fr. Peralta, with the POLST form and the idea of death as a civic duty we are not talking about imminently dying in a day or so from the incurable causes of an illness. The entire objective of the organization promoting the POLST form is the human choosing of when to die be it the early stages of an illness, the mid-stages of advancing illness, or no illness at all. This is the idea of assigning to the patient the time and manner of death. POLST means doctors orders, not if the doctor or the hospital chooses. This is the Compassion and care folks implanting the idea of surrendering one’s life for the benefit of society due to cost, family suffering, whatever. It has nothing to do with death from natural causes unless you consider starvation and dehydration a natural cause.
This is usually death by morphine. If the POLST form could be considered a gun, then morphine would be the bullets it shoots.
There is something to say about a loved one choosing to pass in peace. It may be hard for a loved one to understand that choice, that decision belongs to the person alone. We may say “but you have to support life at all costs” which may apply to someone injured in a car accident, but when an elderly loved one has gotten to the end of their life, and express their thoughts about “heroic means” to keep them alive, that particular scenario does not apply. In 1865 a loved one who was at the end stages of their life did not have CPR as a choice. They were given comfort by family and the vigil began. Such a decision to allow a loved one to pass in peace is not outside the possibility of “comfort care” even though a bright pink piece of paper may seem to indicate otherwise. I think it is a compassionate family who respects the decision of a loved one to pass in peace. Their journey toward Home and Heaven is particular to them, to us all.
In 1865 family care included water and food as tolerated and other comfort measures and no excessive use of morphone/ativan to push them out the door. Extraordinary means of life support means a ventilator and other mechanical and pharmaceutical means that do not have to be continued. Food and water are not extraordinary measures as long as they can be utilized by the person. If they are heavily medicated (but medicated for pain/discomfort) that cannot be determined or used. It is not a natural, but an expedited death.
However, hydration and nutrition by tube or IV is still an extraordinary choice, and is not therefore automatically required by the Church. I’m not advocating what situations one ought to refuse tube feeding, if ever, I just think that we have to be careful to not burden the decision maker(s) with moral teaching which are not what the church actually teaches. Making the POLST into some evil tool of the devil is not at all in keeping with catholic moral teaching.
POLST orders have nothing to do with respecting a natural death or the wishes of the patient. They have everything to do with protecting the medical staff from lawsuits and for the ability to withhold water and food from a person who is still able to utilize it. Hospice “care” quite often means “we will give x amount of morphine and ativan subcutaneously until the person no longer has any ability to eat, drink, converse or object. [and yes there are many wonderful services provided in some hospices and by staff, but you have to know the issues and when a loved one is dying is no time to be on this learning curve!]
Giving medication to a person in the actual process of dying, who is in visible pain is one thing. “Gorking”, as it is known, is done for other reasons: usually to make sure the death occurs in 1.5 days once Hospice protocols are in place. You can actually time the deaths of people in the local hospice house from the time they arrive until they “depart”. When no food or water has been administered 1.5 days is just about the time needed to complete the death process as planned if the right amt of the medications are given. And the family thinks this is a “natural death” like they used to see on the family farm before these things were used. There is nothing similar to the death by morphine that is carefully planned and executed and the observance of what actually happens at a death bed when palliative care is done correctly and not with the motive to actually cause the death. This is an area of bioethics that many people have no grasp or concept of what is ethical by Catholic standards. Study your faith, not the forms given you by your doctor. When in doubt sign for full resuscitation and treatments and allow your spouse/family to guide your care, not the lawyers for the hospital.
The “CATECHISM of the CATHOLIC CHURCH, Second Edition” has the accurate teaching of the Church which all Catholics must adhere to regarding – EUTHANASIA – paragraphs 2276 – 2279.
Please read these paragraphs in entirety prior to making any health care directives, or making any decisions on behalf of incapacitated family members.
Palliative care is also covered in our CCC.
Whatever good you might draw from this article, I pray you do not allow it to dissuade you from documenting your medical decision-making in advance, by whatever means may be available within the jurisdiction you reside.
The POLST is only one of these means available in California, none of which in themselves is evil. They are mere tools: their good or evil is to be determined by the nature of the decisions they reflect.
Do not doubt that decisions as to your medical treatment shall be made. The only question is whether you will avail yourself of the opportunity to influence them in the hope that they will be consistent with the teachings of the Church and natural morality.
Absent some legally-recognized advance health directive, you are exposing yourself and your loved ones to the possibility that, in extremis, you will succumb to the temptation to make a medical decision which is a mortal sin; or, to lead your medical providers into committing such a sin themselves.
I think it is simple prudence, and charity, to prepare yourself and your loved ones for the situation in advance, when you can seek sound spiritual direction and medical/legal advice and consider the decisions in calm and peace.
Perhaps a local “pro-life” group would even consider hosting an event wherein instruction in the meaning and effect of advance medical directives can be given, along with assistance in executing them for those who wish to do so?