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
(Physician Orders for Life-Sustaining Treatment Paradigm) form 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.
It is being promoted under the banner of Palliative Care. People have become highly sensitized to consider that the centuries old idea of health care, such as the Hippocratic Oath, especially end of life health care is unnatural and coldly professionalized being based solely on finances. This subjects the patient and family to terrible suffering and anxiety because the patient’s wishes for a peaceful and natural death have been submerged to the heartless demands of a medical industry objectifying the patient and the family.
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?
So, what’s so ominous about a POLST form?
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 or 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 is 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 A.D. 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 decisionmaker (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? See 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 Central Valley in speaking for Compassionate Care and promoting the POLST form.
On another occasion, during a legislative term, there was a bill that would have mandated assisted suicide. Disability groups opposed the bill. The disability people opposed A.S. because it denied them, as patients, the right to make their own decision regarding their health care and end-of-life decisions, their right to be in control, as it was explained to me.
The form is being quickly accepted because its promoters have learned to use the language of seduction to soothe the concerns of the wary. They have even begun to use pro life terms. We use the phrase: We believe in life from conception until natural death.
The abortion industry changed the definition of conception from the moment that the egg and sperm unite, to meaning the implantation of the fertilized ovum into the wall of the uterus, up to two weeks after fertilization as a way to promote birth control and pills such as RU 486.
The death industry is now changing the understanding of what constitutes a natural death as being one in which all medical interventions, including food and water, are removed and the person dies a medicated and lingering death, regardless of the patient’s age or seriousness of the immediate illness.
They have developed satellite community groups to help sell their product. One of them is a group called: Let’s have the Conversation. This groups trains people on how to discuss the issue of self destruction with friends, family and potential POLST signers. One suggestion they give is that a good time to bring up the conversation is at Thanksgiving, over the turkey dinner and a glass of wine.
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
. See: vitas.com
Banks advertise as “full service banks.” Would you put your money in a bank that claimed we are only a partial service bank? A bank that has full service for some customers, but if you sign this form we’ll promise to only take care of some of your needs?
Why would anyone sign a medical care form that promises to only give you only partial service? Hospitals, especially newly built ones, are crammed with all the most modern up-to-date equipment possible with dozens of operating rooms. Why would they do that if they intended to only use a few or none of these pieces of expensive equipment on you?
Is this advancement in medical care or a step backwards to medieval practices? Is this social justice or discrimination based on a value judgement of your worth? Is this the Christian understanding of life after death or the humanist understanding of human worth and destination?
Spero columnist Camille Giglio is a freelance writer who resides in California.
Coalition for Compassionate Care of California: A statewide partnership of regional and statewide organizations, state agencies, and individuals working together to promote high-quality, compassionate end-of-life care for all Californians. www.coalitionccc.org.
Defining Palliative Care. Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illnesses. It is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. www.capc.org.