POLST Introduces No New Risks

This week, the LA Times published an op-ed opposing POLST.  The writer, Ben Mattlin, concedes that "the attention being given to end-of-life choices is a good sign for those of us who are concerned about patients' rights."  He also concedes that "too many people die in hospitals rather than at home where they'd prefer to be."



But Mattlin also argues that "there's no provision to ensure how well informed you are at the time to make such a decision. . . .  POLST merely hastens uninformed decision-making based on fear."



Mattlin is correct that a patient (or surrogate on behalf of an incapacitated patient) might complete a POLST without fully understanding or appreciating the prognosis or alternatives.  Clinicians might even pressure the patient/surrogate to complete the POLST in a certain way.



But those concerns hardly make for a case against POLST.  

• First, it is an optional an voluntary tool.  If you do not want to complete it, then do not complete it.  


• Second, you can complete a POLST in any manner that you want.  If you want to opt for all life-sustaining measures, then do so.  


• Third, the risks of under-informed decisions are not unique to POLST.  


• Fourth, POLST is for incapacitated patients.  if the patient still has capacity, then she can make her own treatment decisions.

As Mattlin observes, POLST has been proven to have significant benefits in terms of assuring that patients get o more and no less than the treatment they want.  Mattlin and other opponents have not provided persuasive evidence demonstrating that these benefits are outweighed by risks.