Editor’s note: This article is in response to the story “Opinion: Knowing end-of-life wishes crucial for EMS workers”. A recent study in the New England Journal of Medicine found that 1 in 4 elderly Americans will eventually need someone to make a crucial decision about their end-of-life treatment. Read the full story and tell us what you think in the member comments.
By Art Hsieh, EMS1 Editorial Advisor
Being at the side of a person at the end of life is humbling. None of the countless situations I’ve encountered could ever be called routine, certainly not for the family, friends and even strangers who witness the event. The disbelief, sorrow and even anger that survivors express is genuine, raw human emotion that is impossible to ignore. I know that some of you might consider otherwise, but it’s good to be in tune with these feelings, and allow family to respect the deceased and grieve openly and uniquely.
As our society continues to mature in its principles and morals, more people will be wanting to clearly not continue living “at any cost”. There is a quality of life, even when death is nearby. The medical profession has long recognized that while we continue to push the cutting edge of care, we constantly confront the fact that thee will always situations that no level of medicine can fix. Living wills, Do Not Resuscitate forms, and other advanced directives have been part of our vernacular since the 1980s.
Yet, in the haze of a chaotic scene where family may not be prepared to accept dying as the next step for their loved one, it can be a challenge to clearly define the parameters of what care should be withheld, and what care should be provided. EMS is not unique in this aspect; other health care environments encounter similar situations where the line staff can easily be confused by the maze of paperwork and conflicting directions given by family and even physicians who may be involved in the patient’s care.
Similar to Oregon and Washington, the California Physician Orders for Life-Sustaining Treatment (POLST) is a statewide attempt to create one single form that is accessible to all levels of health care. It provides clear, simple directions about whether care is to be withheld or given in an acute situation.
The clarity of the form should provide a better tool for emergency care providers to use when managing what arguably can be an emotionally charged event.
Art Hsieh, MA, NREMT-P, is Chief Executive Officer and Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects.