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LaPOST: An Achievement for Providers, Patients and Families
by Cindy Munn
PUBLISHED: September/October 2011
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My mother was a vibrant, fiercely independent, Cajun
woman who lived alone and looked after herself for
30 years after my father died.
In 2005 and at the age of 78, she needed emergency
surgery. While the procedure was successful, a series of
complications began eroding her health and self-sufficiency
over the next three, sometimes-grueling years until she
passed away in 2008.
Watching her health fade was painful enough. To see her
cherished independence spiral away, however, was almost
too much to bear. She had no, or very little, control in fundamental
decisions on her medical care and, ultimately, how
her life would end.
That left my two sisters and me to make countless difficult
decisions about our mother’s life. Would we keep taking her
back to the emergency room? Should she be resuscitated if
she stopped breathing? At what point do we say no more?
When I joined the Louisiana Health Care Quality Forum
(LHCQF) and learned it was involved in creating the end-oflife
care document that would eventually become LaPOST,
no one had to convince me it was a worthwhile effort.
Composed with input from health care and legal professionals
throughout the state and given final approval by the
Legislature in June 2011, the Louisiana Physician Order for
Scope of Treatment, or LaPOST, is a document that empowers
terminally ill patients to decide for themselves the type
of care they would like to receive when cure is not possible.
LaPOST was created as a best-practice model through
the efforts of the LaPOST Coalition, a statewide network of
Louisiana health care professionals that operates through
LHCQF. Endorsed by the Louisiana State Medical Society,
the Coalition is led by the capable hands of Dr. Susan Nelson,
medical director of senior services for the Franciscan
Missionaries of Our Lady Health System.
Dr. Nelson will be very visible in the coming months as she
takes part in LaPOST outreach programs planned around
the state. “We want the medical community to know that
LaPOST is here and the change it represents,” she said.
“Most of all, we want to help prepare physicians for patients
who ask about LaPOST.”
The document allows terminally ill patients to state their
preferences for end-of-life treatment in a physician’s order.
It is modeled after the Physician Order for Life Sustaining
Treatment, also known as the POL ST Paradigm document,
organized through the Oregon Health Sciences University
beginning in the early 1990s. Louisiana is the latest of several
states nationwide that have developed similar documents
modeled after POLST.
“Medical advancements allow doctors in some cases to
significantly prolong patients’ lives. While some patients
might benefit from that, it may not be the ideal treatment
for everyone,” Dr. Nelson explained. “LaPOST gives patients
who face terminal illness more control in deciding the point
where active curative treatment is no longer attempted and
the focus is on comfort and symptom management.”
LaPOST is completely voluntary and neither for nor
against treatment. The document is publicly available, but
must be completed by a doctor to become valid. It’s printed
on bright gold paper, making it easily recognizable for patients
and caregivers.
Moreover, LaPOST travels with patients throughout the
health care system – from their homes to hospitals to nursing
homes – with clear and concise instructions. The original
document stays with patients, and copies are considered
valid and legal.
LaPOST’s portability is a crucial benefit for patients’ families.
As my mother moved among various health facilities
during her illness, we were forced to constantly repeat and
reinforce her treatment preferences.
LaPOST should be distinguished from two other endof-
life documents – a living will and health care power of
attorney.
A living will, sometimes referred to as an advance directive,
also helps individuals plan and declare their end-of-life
preferences but usually in advance of any illness. A health
care power of attorney document allows an individual to
designate a proxy to make health care decisions. Both documents
become effective if a patient is incapable of making
decisions.
LaPOST, meanwhile, is a physician order recommended
specifically for patients with a terminal illness and a life expectancy
of less than a year. It takes effect if the patient is
unable to communicate and is honored by health care providers
throughout the state.
While all three measures play important roles, LaPOST
was designed to eliminate much of the confusion and heartrending
decisions families often face during a terminally ill
loved one’s last moments of life. As others who’ve faced
similar experiences can attest, this is perhaps the hardest
part. Your head knows what is happening, but your heart
struggles to make a decision.
We agonized, for example, about whether my mother
should continue receiving antibiotics, knowing the medication
wouldn’t change an outcome that was inevitable.
My sisters and I were a united front throughout the
process, reaching consensus on all decisions. We were fortunate
in that respect.
Physicians and providers know all too well that emotions run
very high when loved ones, especially those unable to communicate
or make decisions for themselves, are faced with terminal
diagnoses. In the absence of stated preferences or a clear
plan, routine questions and second-guessing among family
members sometimes balloon into personal and bitter disputes.
T hose are precisely the scenarios LaPOST was designed to
prevent. Family members, as well as caregivers, have peace of
mind knowing that loved ones are treated according to their
own wishes.
Ultimately, my sisters and I decided that above all, we didn’t
want our mother to suffer. In the last several months of her life,
our focus turned to palliative care and ensuring she remained
comfortable. Through an extraordinary bit of coincidence, luck
or perhaps fate, her hospice care was overseen by Dr. Nelson,
who demonstrated an inspiring level of compassion and personal
concern during my mother’s remaining time with us.
A few years later when Dr. Nelson and I were reacquainted
through the LaPOST Coalition, I knew firsthand that she was
among the very best to lead this effort with a deft understanding
of countless related issues. She knows, too, that the hard
work is just beginning.
“Though the document is complete, we’re still in the early
stages of education and awareness,” Dr. Nelson said. “We’ll be
meeting with medical professionals to fully explain LaPOST and
the resources that are already available on our website, www.
la-post.org.”
As a private, nonprofit organization, LHCQF is committed
to improving health care for all Louisiana residents through a
number of initiatives. I have no doubt that LaPOST will be one
of the most important moving forward.
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