Living Will' Could Be Open to Interpretation at the ER

A report from the Pennsylvania Patient Safety Authority treats misunderstandings involving end-of-life documents as medical errors, according to the Washington Post . The report estimates that in 2016, Pennsylvania hospitals reported nearly 100 events relating to persons' "code status" — their wish to be resuscitated or not. Individuals were resuscitated against their wishes in 29 cases, while in two cases they were not resuscitated despite making it clear they wanted this to happen. Authority Executive Director Regina Hoffman says doctors and nurses receive little, if any, training in understanding and interpreting living wills, do-not-resuscitate (DNR) orders, and Physician Orders for Life-Sustaining Treatment (POLST) forms, either on duty or in medical or nursing school. Research suggests the potential for confusion concerning end-of-life documents is broad. The Medical College of Wisconsin's Arthur Derse recommends people ensure they have ongoing discussions about their end-of-life preferences with their physician, surrogate decision-maker, and family. A living will is designed to express preferences for end-of-life care but is not a binding medical order. Medical staff will instead interpret it based on the situation at hand, with input from the subject's family and surrogate decision-maker. Living wills are invoked only when a person is terminally ill and unconscious or in a permanent vegetative state. DNRs are binding medical orders, signed by a doctor, that apply specifically to cardiopulmonary resuscitation and instruct staff not to administer chest compressions if someone stops breathing or their heart stops beating. A POLST form is a set of medical orders for someone expected to die within a year, signed by a physician, physician assistant, or nurse practitioner; they are meant to be prepared after a detailed conversation about the person's prognosis, goals, and values, and the potential benefits and harms of various treatment options.