Selective Killing Fields: POLST in Action

March 22, 2011 - 5:30 PM

“In my practice, while I steadfastly refuse to write a prescription with lethal intent or otherwise help the patient commit suicide, I can share with the patient information that he or she already has the ability to exert control over the time [of] death. Virtually any patient with far-advanced illness can be assured of dying—comfortably, without any additional physical distress—within one or two weeks simply by refusing to eat or drink.” – Ira Byock, M.D., American Journal of Hospice and Palliative Care, March/April 1995

Hospitals and nursing homes are becoming (or have already become) selective killing fields. POLST (Physician Orders for Life-Sustaining Treatment) is another in a long line of efforts to persuade people to refuse medical treatment. Living Wills and Powers of Attorney for Health Care (advance directives) have not been as successful in this area as their creators in the right-to-die movement had hoped they would be.

Put quite simply, POLST protocols and laws are the “death with dignity” squad’s latest attempt to select those whose lives are viewed as “futile” in order to ensure their speedy demise. POLST forms are designed to limit the use of life-saving technology, life-sustaining treatment and even ordinary care, such as the provision of food and water.

“Compassion” and “patient autonomy” are the alleged motives for promulgating POLST forms. However, a look at their origin tells a different story.

Analysis of the POLST movement “reveals that it is a national effort to manage and control death under the guise of compassion.” (Ethics and Medics, 6/2010, “The Danger of POLST Orders.”) The usual cast of characters is involved in this latest effort to advance the “right to die.” POLST was developed in the 1990s by the ethics group at Oregon Health & Sciences University, the group that also developed the Guidebook to the Oregon Death With Dignity Act (Oregon’s physician-assisted suicide law).

POLST was developed with grants from George Soros’ Project on Death in America, as well as the Greenwall Foundation and the Cummings Foundation, all frequent sponsors of right-to-die organizations. Compassion & Choices (formerly the Hemlock Society) promotes POLST. (For more detailed information/a timeline, go to www.lifetree.org.) POLST was one of the outcomes of the Project on Death in America.

On Nov. 9, 2003, the Boston Globe (Carey Goldberg, Globe Staff) reported, “The Project on Death in America, financed by billionaire George Soros and the Robert Wood Johnson Foundation, poured more than $200 million over the last decade into end-of-life programs and research.”

The POLST form differs from a Living Will or a Power of Attorney for Health Care (advance directives) because, once signed by a physician, it is the physician’s orders and may therefore be carried out immediately. Furthermore, the law governing advance directives, which requires two physicians to certify that the patient is capable of making medical decisions, will not apply to a POLST form. POLST leaves the patient wide-open for abuse.

The proposed Wisconsin POLST law is extremely flawed from a moral point of view.

The analysis introducing the POLST bill states that the withholding or withdrawal of treatment under this bill “does not constitute suicide.” If a person chooses to have withheld or withdrawn treatment or care that is life-sustaining, is this not a death wish and suicide/assisted suicide if carried out?

The bill itself states (7)(g), “Nothing in this section condones, authorizes, or permits any affirmative or deliberate act to end life other than to permit the natural dying process.” What does this mean? Is death by dehydration a “natural dying process” for a person in a persistent vegetative state, or a person with a life-limiting illness, or anyone else, for that matter? Does denial of medical treatment or care that could prevent death merely permit a “natural dying process”?

The POLST philosophy is that patient autonomy is paramount. That is completely contrary to Catholic moral teaching. “A person has the moral obligation to use ordinary or proportionate means of preserving his or her life.” (USCCB, Ethical & Religious Directives)

The POLST form—a physician’s preprinted order sheet—has check boxes to refuse even very ordinary things, including food and fluids. This is contrary to authentic Catholic moral teaching regarding medical decision-making. Whether or not to provide/receive nutrition and hydration is not a choice. They are either medically contraindicated (because they are actually causing harm to the patient or because the patient’s body can no longer assimilate food and fluids) or they must be provided. 

            a. In March of 2004, Pope John Paul II addressed the International Congress on Life-Sustaining Treatments and Vegetative State. He unequivocally stated that withholding hydration and nutrition from patients when these will sustain their lives is wrong and that death by starvation and dehydration “ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.”

              b. In 2007, the Congregation for the Doctrine of the Faith strongly reinforced this papal instruction, writing to the bishops of the United States: “The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.”

POLST forms are typically filled out as the patient’s condition changes/worsens, frequently when the patient and his/her agent are under stress. POLST forms supersede previously signed advance directives. Would the same wishes (as are expressed when the physician checks boxes in the POLST form) have been expressed by the patient/agent in a less stressful situation? Since the POLST form overrides the patient’s Power of Attorney for Health Care and the physician’s orders in the POLST form are generally carried out immediately, POLST is extremely dangerous. 

Confronting patients with such difficult and fateful decisions during a time of crisis seems particularly heartless, especially when they have already signed a Power of Attorney for Health Care expressing their values and carefully stated wishes. Assisted suicide proponent Ann Jackson testified before a Senate subcommittee in 2006.

During the course of her testimony in favor of assisted suicide, she said that one of Oregon’s successes was POLST. She claimed that “respect for end-of-life wishes is virtually 100% when POLST…is in place.” (Testimony before the Senate Judiciary Committee’s Subcommittee on the Constitution, Civil Rights and Property Rights, “The Consequences of Legalized Assisted Suicide and Euthanasia,” 5/25/2006.)

But does a POLST form accurately convey a person’s wishes and values? Filling out the POLST form includes a coaching process designed to elicit the patient responses desired by the physician or other medical professional who is checking the boxes. It is actually not difficult to “clarify” away a distressed patient’s previously expressed wishes by presenting what a medical professional considers “realistic options.” (Medical professionals receive special POLST training in this regard.)

POLST sets the stage for neglect, substandard medical treatment, and cost-saving at the expense of patients’ lives. Although POLST promoters steer clear of mentioning the money motive, it is undoubtedly a factor in efforts to limit treatment.

G.K. Chesterton, in “What’s Wrong With the World?” answered that question: “What is wrong is that we do not ask what is right.” We ask what is quick and convenient, what is useful, what is cost-effective—not does this course of action/inaction respect this person and his or her life?

The most “right” thing we can do is love and respect one another and ourselves. Even if we do not love perfectly, at least we must try to do what is right, not merely what is easy. The sick person should not be offered the option to hasten his or her death, particularly when weak, in pain, feeling overwhelmed or just plain tired of fighting.

Have we grown cold? Have we lost the fervor of our conviction that every human being has dignity and is worthy of life? Those of us who are pro-life must vigorously oppose the POLST movement. We must protect the lives of everyone—including ourselves. We must never succumb to the false compassion of those who see planned death as the final solution to human suffering and the burden of caring for one another.

POLST advocates will not accept “no.” They will keep reintroducing POLST bills. Be vigilant.