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POLST

POLST. Physician Orders for Life-Sustaining Treatment. Erica Laethem, BeL , PhD(c) and Amy S. Martin, MA Directors of Clinical Ethics, Presence Health. Objectives:. Describe the features of Illinois POLST Evaluate Illinois POLST from the perspective of Catholic Moral Tradition

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POLST

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  1. POLST Physician Orders for Life-Sustaining Treatment Erica Laethem, BeL, PhD(c) and Amy S. Martin, MA Directors of Clinical Ethics, Presence Health

  2. Objectives: Describe the features of Illinois POLST Evaluate Illinois POLST from the perspective of Catholic Moral Tradition Identify when the use of an Illinois POLST document may be helpful

  3. Roadmap Brief review of Catholic Moral Tradition on care for the seriously ill and dying Introduction to the nuts and bolts of Illinois POLST

  4. Care for the Seriously Ill and Dying Catholic Moral Tradition on The full text of The Ethical and Religious Directives for Catholic Health Care Services, Part V, and an analysis of Illinois POLST in light of the ERDs can be found in your manual.

  5. Catholic Moral Tradition on Care for the Seriously Ill and Dying Human life is a gift. We are stewards, not owners, of our lives. We have a duty to preserve our lives, but this duty is not absolute. We may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome. We should never intentionally take our lives or the lives of others, either by action or by omission.

  6. Avoid Extremes Direct Killing • E.g. Euthanasia, assisted suicide “Therapeutic Overkill”

  7. Care for the Whole Person The whole person must be taken into account in considering any therapeutic intervention. Therapeutic procedures that are likely to cause harm or undesirable side-effects can be justified only by a proportionate benefit to the pt. (Cf. ERD 33)

  8. Respect Informed Judgment Persons in danger of death should be provided with information necessary to help them understand their condition, to discuss their condition with family members and care providers, to participate in their healthcare conditions, and to prepare for death. The free and informed judgment should be respected so long as it in conformity with ethical and legal principles. (Cf. ERD 55, 59)

  9. Manage Pain Pts should be kept as free of pain as possible so that they may die comfortably and with dignity, and in a place where they wish to die. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death. (Principle of Double Effect) (Cf. ERD 61)

  10. Allow Preparation for Death A person has a right to prepare for his or her death while fully conscious. Pts should not be deprived of consciousness without a compelling reason. (Cf. ERD 61)

  11. Proportionate Means “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” (ERD 56, emphasis mine)

  12. Disproportionate Means “A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.” (ERD 57, emphasis mine)

  13. Nutrition / Hydration As a general rule, NH should be provided NH should not be withheld or withdrawn with intention of causing death NH is morally optional if providing it: • Is not expected to prolong life; or • Would be “excessively burdensome” for the pt; or • Would cause significant physical discomfort (e.g. resulting from complications in use of means employed); or • Would offer limited ability to prolong life or provide comfort in pt who is drawing close to inevitable death from a progressive and fatal condition. (Cf. ERD 58)

  14. When can an intervention be considered “excessively burdensome”? Traditionally, an intervention of has been considered “excessively burdensome” when it is: “too painful, too damaging to patient’s bodily self and functioning, too psychologically repugnant to the patient, too restrictive of the patient’s liberty and preferred activities, too suppressive of the patient’s mental life, or too expensive.” William E. May et al., “Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons,” Issues in Law and Medicine, Volume 2 (Winter 1987), p. 208, quoted in United States Conference of Catholic Bishops, “Questions about Medically Assisted Nutrition and Hydration,” available at http://www.nccbuscc.org/prolife/issues/euthanas/nutqa.shtml

  15. The Nuts and Bolts of Illinois POLST

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