Mitigating Risks of POLST Abuse Increases Other Risks

Many are concerned that POLST might be abused by surrogates or clinicians to hasten the death of patients and residents who, were they fully informed of their prognosis, would not want their death hastened.



Most POLST statutes and laws have adequate safeguards to mitigate these risks.  But it is dangerous to erect too many safeguards or safeguards that are too onerous.  Once a "baseline" of safeguards is put into place, adding more offers zero or only small marginal benefit.  Yet, it imposes other material costs. 



For example, suppose that limiting signature authority to MDs had some small marginal benefit.  (In fact, most states eventually expand to NPs and PAs.)  It is surely not even a close balance that any such benefit would be greatly outweighed by the harm from thousands of LTC residents being unable to complete or update POLST due to limited access to MDs.  



Those who struggle too hard to limit or eliminate some small risks are increasing other greater risks, especially the risk of unwanted prolongation of life that the patient herself finds intolerable.