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POST helps crystallize end-of-life decisions

Imagine you’re in the twilight of life. You’re no longer the young and healthy person who would want everything medically possible to be done. You know what’s coming and you’re not afraid. Just last week you told someone that you know the end is near and you are ready. And you keep repeating that you don’t want to die in an ICU, hooked up to machines. And now someone has found you, unconscious and nonresponsive. Should they call 911?

If they call 911, the emergency medical personnel will come, they will do what they can to save your life unless there’s a medical order telling them otherwise. This puts the person who found you in an awkward position. Their choices are black and white: call 911 or don’t; call for aggressive medical care or no medical care. And worst of all, they’re not a doctor, so they can’t make a good medical judgment about your condition.

But it doesn’t have to be like this. As of July 1, there’s a new kind of medical order in Indiana that’s meant for this kind of case. Specifically, it’s for three types of seriously ill patients: those with advanced chronic progressive illness, with advanced chronic progressive frailty, or with terminal conditions. The POST (Physician Order for Scope of Treatment) form is a new kind of medical order that identifies the patient’s preferences for the scope of their medical care and gives it the weight of a medical order.

There are a few key facts you should know about the POST form. First, no one can force a patient to have a POST form – to be valid, it must be signed by the patient (or their legally appointed decision-maker). Second, it’s only for certain patients (see above). Third, it has to be signed by a physician. Both signatures should be preceded by a discussion of the patient’s medical condition and the likely outcomes of various levels or types of intervention. There is far more to know about POST – visit www.indianapost.org to find out.

Keith Huffman and I recently talked to a group of caregivers at Aging and In-Home Services; this led many to ask: Should I (or my loved one) consider having a POST order placed? The answer should be found in consultation with your doctor. As a medical order, the POST form should represent a shared understanding of your medical condition and the appropriate scope of treatment for you.

Your doctor may be unaware of POST, so bring this with you and if they have questions, they can reach out to me or someone on the indianapost.org website.

Abraham Schwab is a medical ethicist and associate professor of philosophy at IPFW. He wrote this for The Journal Gazette.

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