Quick Links
|
Labels: dead donor rule, FAMiLY LEADER, Organ Donation, POLST
|
Labels: dead donor rule, FAMiLY LEADER, Organ Donation, POLST
As to the exemption, the comments detail how it “is narrower than any conscience clause ever enacted in federal law, and narrower than the vast majority of religious exemptions from state contraceptive mandates,” wrote Picarello and Moses. “By failing to protect insurers, individuals, most employers, or any other stakeholders with a religious objection to such items and procedures, the HHS exemption, like the mandate itself, violates” the U.S. Constitution and various federal statutes.
This definition is so narrow that it excludes almost all Catholic institutions as they now operate. The conjunction, “and” before the fourth article ensures that almost no religious organization satisfies the criteria; “or” would have been limiting, but “and” is crippling. Catholic hospitals, schools, and charities do not serve primarily Catholics, they serve everyone; there is no baptismal requirement to receive services from Catholics. We do not serve people because they are Catholic; we serve people because we are Catholic. And the same goes for members of other religious groups.
Many historians trace the birth of the War in Crime to the mid-1960s–specifically, to Barry Goldwater’s 1964 presidential campaign, with and his rhetoric of “crime in the streets” and the need for “law and order.” Since that time, politicians have increasingly exploited the fear of violent crime and its perpetrators to institute ever more draconian laws and policies. The War on Crime was soon joined by its partner the War on Drugs, which was launched by Richard Nixon and gained traction during the Reagan Administration. One crime bill after another was passed with broad bipartisan support, and more and more federal and state monies were poured into expanding law enforcement and building and maintaining prisons. Between 1970 and 2005, the U.S. prison population grew by 700 percent.
The POLST-type legislation removes the condition that a patient is terminally ill or diagnosed in a PVS before a refusal order is actionable. In other words, the new law permits any adult patient to refuse any treatment at any time for any reason in the event they lack decisional capacity; and health care professionals, directed by a doctor's medical order, ordinarily would be (and are) required to carry out the order. Although the law for strategic purposes is rhetorically formulated as bearing upon end-of-lifemedical decisions, it sets forth no requirement that a patient's refusal of life-support must be limited to end-of-life conditions.
Labels: catholic church, Colorado, contraception, POLST, vsed
Over the last 30 years we have tried to standardize patient communication about end-of-life issues though the utilization of statutory advance health care directive forms. While this approach has not been a complete failure, the results have been less than stunning given the amount of resources allocated to this endeavor. Is there a better way? At the Coalition for Compassionate Care of California (CCCC) Annual Meeting, Charles Sabatino, JD, talked about one possibility – the POLST paradigm.
Mr. Sabatino is the Assistant Director of the American Bar Association’s Commission on Law and Aging, as well as a professor at Georgetown University Law Center. At today’s CCCC meeting, Mr. Sabatino gave a presentation on the inadequacy of a legal transactional approach that has dominated advance care planning, best exemplified by the Advance Directive document. He describes how the transactional approach is beginning to give way to “communication approach” to advance care planning, where shared decisions are made between patients, families, and healthcare providers on a ongoing basis. The communication approach requires healthcare providers to learn about the goals and values held by their patients, which is then converted into a portable plan of care: the POLST.
The POLST paradigm does not attempt to standardize patient communication about preferences at the end-of-life. The Advance Directive still attempts to accomplish this, although as it is a complex and highly individualized process, standardization becomes difficult. Rather, as Mr. Sabatino points out, POLST attempts to standardize physician end-of-life orders for patients with serious illnesses. The goal is to translate the complex discussions around the values of patients into specific medical orders. The standardized forms include orders addressing:
- Cardiopulmonary resuscitation
- Administration of antibiotics and IV fluids
- Use of intubation and mechanical ventilation
- Use of artificial nutrition
Twelve states have adopted the POLST paradigm into law (CA, HI, ID, MD, NY, NC, OR, TN, UT, WA, WV), and many more are developing programs. My state (California) has signed the POLST into law, although implementation in San Francisco is spotty at best.
I’m interested in hearing from the GeriPal community what they think about the POLST. Have you used it? What are your concerns with it? What do you think are the strengths and weaknesses? Please comment and discuss!
Labels: advance directives, end of life care conversation, POLST