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Program puts end-of-life decisions in order

3 min read

WEST PALM BEACH, Fla. — It’s a conversation nobody wants to have — but one that everybody needs to have, especially the older we get.

There’s no easy way to initiate a frank discussion with your loved ones about the family’s preferences in regard to “end-of-life” planning and lifesaving medical intervention.

But far better to do so now — while you’re capable of making those decisions yourself.

Perhaps you’ve already done so with a living will and/or advance directive. But, historically, there are problems with those documents, says Dr. Stuart Bagatell, an internist with JFK Medical Center and instructor at the University of Miami Miller School of Medicine at Florida Atlantic University.

“First, because they’re written in legalese, they’re often just too ambiguous to be medically useful,” he explains. “Second, and more importantly, doctors, EMTs, next of kin — nobody is legally required to follow those often-ambiguous instructions.”

That’s why Bagatell has become one of Florida’s biggest advocates for the Physician Orders for Life-Sustaining Treatment paradigm — or POLST (polst.org).

As the movement’s website explains, “The National POLST Paradigm is an approach to end-of-life planning based on conversations between patients, loved ones and health care professionals designed to ensure that seriously ill or frail patients can choose the treatments they want or do not want and that their wishes are documented and honored.”

Law of (some of) the land

Initially conceived in Oregon in the early 1990s, 15 states have enacted POLST laws — but Florida is not among them.

In states that have passed POLST legislation, the standardized POLST forms that are signed by both patients and their doctors are legally binding.

“They’re medical orders, signed by a physician, so all other health care providers — nurses, EMTs, paramedics, etc. — can feel confident and comfortable in following them,” notes Bagatell.

Since moving to South Florida from New Orleans in 2008, Bagatell, a 39-year-old married father of two originally from Long Island, has been passionate about trying to persuade the Florida Legislature to adopt the POLST paradigm.

He’s been working closely with the folks at Florida State University’s Center for Innovative Collaboration in Medicine and Law to further the POLST cause.

In addition, in 2011, he helped launch the POLST pilot program at JFK Medical Center — where, he says, his colleagues “have been enthusiastic about implementing it.”

Bagatell also travels all over Palm Beach County explaining the POLST paradigm to residents of nursing homes, assisted living facilities and physical rehab centers.

For those who want to fill out a POLST form — which includes sections on cardiopulmonary resuscitation, medical interventions, artificially administered nutrition and palliative care — Bagatell walks them through the process.

Bagatell has observed that “most people tend to feel a sense of relief after making their end-of-life wishes known.”

And, while the POLST paradigm was first created for those facing terminal conditions, Bagatell believes “everyone — no matter their age — can benefit from filling out this form.”

After all, a serious accident or sudden illness could thrust any of us into a life-threatening crisis.

Perhaps, then, we should all make the completion of a POLST form one of our New Year’s resolutions.

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