Approve registry for end-of-life choices

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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As a forward-thinking person facing a chronic or terminal illness, you may believe you’ve made your end-of-life wishes known. Let’s say you’ve fully discussed your preferences with your health care professional and had them complete a POLST (Provider Orders for Life-Sustaining Treatment) that clearly states your preferences on measures that could be used to keep you alive should your heart or breathing stop.

Still, that wish list may not be honored. What if EMTs show up at your house and the form isn’t readily available to them or your loved ones? And even if you posted it on the fridge, as is recommended, your emergency might occur while you’re at the grocery store miles away from your home.

That’s why Minnesota lawmakers are proposing an electronic registry that would make POLST information instantly accessible to medical professionals statewide. Currently, that material is only available in written form that may or may not be available to EMT crews when they rush to the scene of a heart attack or other medical emergency.

To ensure that patient decisions are followed — especially at the end of life — the Minnesota Medical Association (MMA) supports the registry as one of its legislative priorities. During a recent meeting with MMA representatives, Star Tribune Editorial Board members were told that some doctors have patients for whom they completed a POLST, but the wishes were ignored because the written form couldn’t be found at the time of the emergency.

POLSTs are not new. The MMA created standardized POLST forms in 2010, and most other states have them as well. Making it available electronically would not create any extra work for patients. With patient permission, it would simply make the information more accessible.

The proposed registry would be managed and staffed by the state Minnesota Health Department. The agency would maintain the electronic files and staff a hotline to call for the information should the internet be down or not available where the emergency occurs. During the last session, lawmakers created work group to recommend details for the registry, and that group recently issued its report.

State Rep. John Huot, DFL-Rosemount, a former EMT and bill sponsor, told an editorial writer that most EMTs have been in situations in which they employed all lifesaving measures even though the patients may not have wanted them.

“I’m more than proud to support the registry … we should be able to get total support on this,” he said. “Some of the things we do can get pretty graphic,” including breaking ribs to resuscitate, inserting multiple IVs and using ventilators. “If patients don’t want all that, we should know it.”

It’s important not to confuse the POLST process with medical aid in dying — a separate issue being debated in Minnesota. Though they both have to do with end-of-life, allowing a natural death to occur is not the same as facilitating the termination of life.

And while a POLST can replace a DNR (do not resuscitate) order, it differs from an advance directive. An advance directive names those who are able to make medical decisions for you when you cannot communicate or participate in those discussions. That person cannot be identified using a POLST form.

In addition to the registry, it’s important to increase awareness about POLST among both patients and doctors, said Dr. Victor Sandler, a geriatric and palliative care physician and co-chair of the state POLST steering committee. He told an editorial writer that more of these conversations need to occur between health care professionals and patients.

“People have the right to decline aggressive medical treatment,” he said. “Alternatively, they can say they want CPR or to be taken to ICU.”

To make sure those choices are honored, Minnesota should pass the bill sponsored by Huot and state Sen. Judy Seeberger, DFL-Afton, who also works as an EMT, and create the statewide registry. In the meantime, Minnesotans with questions about POLSTs and advance directives should talk with their medical providers.