Professor Lance Tibbles Appointed to Task Force on End-of-Life Care

March 15, 2007

Professor Lance Tibbles, of Capital University Law School, has been appointed to the Honoring Wishes Task Force of the Ohio Hospice & Palliative Care Organization. This task force, comprised of professionals from emergency medical services, emergency room physicians and nurses, hospital administrators, and home health providers, as well as legal and medical experts on end-of-life-care, will examine Ohio palliative care and end-of-life healthcare policies. In particular the task force is asked to recommend improvements in Ohio’s present “do not resuscitate” policies. It will also analyze the “POLST Paradigm” for possible adoption in Ohio.

In the absence of workable advance directives or do-not-resuscitate orders, patients usually receive advanced cardiac life support by emergency medical personnel even if that is not their desire. Ohio’s Living Will and Health Care Power of Attorney statutes provide for the refusing or withdrawing life-sustaining medical treatment only when the person is permanently unconscious or is in a terminal condition. In addition, advance directives are not physician orders and they cannot be followed by emergency medical technicians.

Ohio’s Do-Not-Resuscitate statute allows emergency medical workers to honor a person’s physician-written DNR Order. The Ohio Department of Health established two types of DNR Comfort Care Orders that allow people to choose the extent of the treatment they wish to receive at the end of life. The DNR Comfort Care-Arrest Order directs health care providers to use all appropriate medical treatment including resuscitation, until the patient is in cardiac or pulmonary arrest. At that point only comfort care is to be provided. The DNR Comfort Care Order allows for only comfort care to be provided even before cardiac or pulmonary arrest. Healthcare workers often do not understand the difference between the two types of Comfort Care Orders. Terminally ill individuals may be unaware that they can refuse CPR or they may believe that a Living Will grants this without a physician’s order. In the midst of a crisis, first responders are often presented with an invalid or incomplete DNR Order Form.

POLST (Physician Orders for Life-Sustaining Treatment) Paradigm forms are in use in some states. This form is a physician’s order that indicates the types of life-sustaining treatment that a seriously ill patient does or does not want. The physician uses the POLST form to present the patient’s wishes as clear, specific written medical orders. It can indicate either full treatment including resuscitation attempts or it can be used to limit those interventions that are not desired by the individual. The POLST paradigm is designed to aid the physician and the patient in developing end of life treatment plans that reflect the patient’s values and wishes and to assist physicians, nurses, and emergency personnel in honoring the patient’s wishes for life-sustaining treatment. In addition, POLST grants portability between healthcare facilities.

Professor Tibbles has been actively involved, for over three decades, in the ethical and legal issues in death and dying and respect for patient autonomy. An early advocate of the use of advance directives to promote respect for autonomy and to aid healthcare professionals in end-of-life care, Professor Tibbles will investigate the potential for the POLST Paradigm to surmount the inherent difficulties with the current use of advanced directives and do-not-resuscitate orders in Ohio.