IOM to Tackle POLST

Later this month, the IOM Committee on Approaching Death: Addressing Key End of Life Issues will hold its third meeting in Houston.  



The agenda includes sessions on (1) clinical ethics, (2) addressing spiritual and religious issues, and (3) empirical and legal issues regarding POLST.  Here is the description of the POLST session.



Critical overview of empirical evidence regarding the impact of POLST on clinical care and

outcomes. Does POLST lead to fewer days in the Intensive Care Unit in the last week of life,

CPR before death, etc.? Do states that have robust POLST programs have different levels of

specific medical interventions in end-of-life care? Does POLST reduce disputes regarding end-of-life decisions? Does POLST prevent complicated grieving by survivors or decision regret?

Susan E. Hickman, PhD

Associate Professor, Indiana University School of Nursing

Co-Director, RESPECT Signature Center, IUPUI

Senior Affiliate, IU Health Fairbanks Center for Medical Ethics



Challenges and limitations in advance care planning and POLST, with particular attention to

vulnerable patients. The importance of conversations in advance care planning as well as

documentation of orders and the challenges in improving these conversations.

Rebecca Sudore, MD

Associate Professor of Medicine

University of California, San Francisco



What legal issues might present challenges to a patient and family who wish to use the POLST

form or other types of advance care planning? May a surrogate complete a POLST for a patient

who has already lost decision-making capacity? Are there restrictions on using POLST to

decline feeding tubes in patients with severe dementia or stroke? Are these limitations

communicated effectively to patients and families using POLST? Have there been cases

involving POLST in the courts? What other legal approaches to advance care planning have

states implemented, such as default priority for surrogates and oral appointment of health care

proxies, and how have they worked in practice?

Alan Meisel, JD 

Director, Center for Bioethics and Health Law

Dickie, McCamey and Chilcote Professor of Bioethics, and Professor of Law and 

Psychiatry

University of Pittsburgh