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January 19, 2016

The Problems With Physician Orders for Life-Sustaining Treatment

Author Affiliations
  • 1Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia
  • 3Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
JAMA. 2016;315(3):259-260. doi:10.1001/jama.2015.17362

In 1991, physicians in Oregon developed the Physician Orders for Life-Sustaining Treatment (POLST) program to address a specific and substantive problem: due to societal defaults toward cardiopulmonary resuscitation (CPR) and life support absent orders to the contrary, many seriously ill patients receive unwanted resuscitation and hospitalization. By making physicians’ orders portable, the original intent of POLST was to provide legal authority for emergency medical services personnel (ie, paramedics and emergency medical technicians) to not attempt CPR for patients who had requested that CPR be withheld. In contrast to advance directives, which provide guidance for clinicians and family members in the future if a patient were to become terminally ill or permanently unconscious, POLST enacts legally valid medical orders for current treatment.

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