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Doris is 98 years old. She lives in a small town with her devoted daughter, Tina, 70, who is a retired doctor.
Doris has become very frail as she has aged. Tina is healthy now, but she was diagnosed with advanced ovarian cancer two years ago and knows that her cancer will probably return.
In their kitchen, posted side by side on their refrigerator, are two brightly colored POLST magnets. These magnets show that they have completed POLST (Portable Orders for Life-Sustaining Treatment) forms to let people know what medical care they want (and do not want) when they become sicker and have a medical emergency.
Doris and her doctor* completed her POLST form years ago. As her health has changed, she has changed her form several times to make sure that it fits her current goals for medical care.
At first, she used her POLST to say she wanted treatment for anything she might need — except for if her heart stopped. Later, she changed her form to say that she did not want to go to the hospital if she had a stroke. Today, now that she is very frail, her form clearly says that she does not want to go to the hospital for any reason unless her comfort cannot be managed at home.
Changing her form over the years has allowed Doris to make sure that her instructions about her medical care are right for how sick she is. She is now very certain that she wants to be at home when she dies, and having a POLST gives her peace of mind that this will happen.
Each time she has changed her form, Doris has talked with both her family and her doctors so that they all understood how and why her wishes are changing. These conversations are very important and help everyone understand what matters most for the patient.
Tina, too, sees her POLST form as something she might change over time. Even though she is cancer-free now, she knows that that there is a good chance her cancer will come back and then she will be very sick.
For now, her form states that she does not want most treatments if she has a medical emergency. “As a doctor, I have seen what happens when people hold on too long, and what that does to the quality of life,” she says. “I would rather have a quiet death, even if it is earlier than people expect.”
But Tina also knows that she might change her mind if there are new treatments for ovarian cancer that give her a better chance of living well if her cancer returns. Knowing she can change her POLST gives her peace of mind too.
For both Tina and her mom their POLST is a very important part of their medical care. It is empowering for them to know that they have a POLST to make their wishes known. And that they can change it at any time if their situation changes.
Click here to download POLST: Changing Your Wishes As Your Situation Changes
* “Doctor" refers to who can sign a POLST form. POLST forms need a physician (M.D. or D.O.), nurse practitioner (N.P.), physician assistant (P.A.), or doctor of naturopathy (N.D.) signature.