Oregonians appear to making progress in an area that most of us likely would prefer not to think too much about: our mortality.
A new study finds that we're doing a better job of making it clear what sort of medical care we prefer at the end of our lives, even in cases when we are unable to articulate those for ourselves because of some sort of medical emergency.
The key tool here is a document called a Physician Orders for Life-Sustaining Treatment (POLST). People can use the forms to document their preferences regarding the use of life-sustaining treatment. The idea is that the document can articulate your wishes even if you cannot, for whatever reason. Ideally, medical providers have access to a patient's POLST documents and abide by their instructions.
You want your provider to take every possible lifesaving measure in the event of an emergency? You can make sure that's what your POLST calls for. However, if you prefer that medical providers eschew elaborate lifesaving measures, you can indicate that as well.
A recent study from a group of Oregon Health & Science University researchers, along with one from Harvard's Dana-Farber Cancer Institute, found a substantial jump in the percentage of state residents who had filed the POLST form. A story in The Oregonian newspaper about the study reported one key finding: About 31 percent of people who died from 2010 to 2011 had a POLST on file with the state's registry. Five years later, that number had jumped: Of the people who died from 2015 to 2016, almost half (45 percent) had a POLST on file.
As you might imagine, older Oregonians are more likely than their younger counterparts to have a POLST on file: The newspaper said that of people 95 and older, almost 60 percent have a form on file, an increase of 83 percent over the last five years.
But the POLST exercise is catching on among people in their 60s and 70s as well: The number of people between 65 and 74 who had a POLST on file when they died jumped 31 percent in the five years between 2010 and 2015.
Younger people who decide to fill out a POLST earlier rather than later sometimes decide to change their wishes about what kind of life-sustaining treatment they prefer, and that's OK: Nobody is locked into decisions they have made years before. The important thing is to be sure that you regularly review your medical orders with their physicians and with family members.
The study also uncovered an interesting trend: Of all the people who had a POLST form filled out when they died in 2015 or 2016, 13 percent requested that every possible lifesaving measure be taken; that was up from 8 percent five years ago. This is a trend that may be worth additional study, although our guess is that's a natural result of the fact that younger people are starting to file POLST forms; as people become older, they may be more likely to opt for limited treatment or comfort issues only.
Oregon has a long and proud tradition of leading the nation in these end-of-life initiatives, and these POLST forms aren't an exception: The state leads the country in terms of how many people have a POLST form.
These POLST forms can be valuable tools to ensure that our medical wishes are honored even during medical emergencies when we may not be able to clearly communicate with medical providers.
But they also can be valuable as a starting point for difficult conversations that are easy to put off — after all, who likes to talk about death? Of course, not talking about it does nothing to keep it at bay. But talking about these questions now can help ensure that we can die on our own terms. (mm)