Ann Emerg Med. 2014 Apr 14. pii: S0196-0644(14)00220-0. doi: 10.1016/j.annemergmed.2014.03.014. [Epub ahead of print]

Physician Orders for Life-Sustaining Treatment and Emergency Medicine: Ethical Considerations, Legal Issues, and Emerging Trends.

Jesus JE1, Geiderman JM2, Venkat A3, Limehouse WE Jr4, Derse AR5, Larkin GL6, Henrichs CW 3rd7; ACEP Ethics Committee.

Author information

• 1Christiana Care Health Center, Newark, DE. Electronic address: jjesus@christianacare.org.
• 2Cedars-Sinai Medical Center, Los Angeles, CA.
• 3Allegheny Health Network, Pittsburgh, PA.
• 4Medical University of South Carolina, Charleston, SC.
• 5Medical College of Wisconsin, Milwaukee, WI.
• 6University of Auckland, Auckland, New Zealand.
• 7University of Auckland, Auckland, New Zealand; Pardee UNC Health Care, Hendersonville, North Carolina.

Abstract

Since its original development in Oregon in 1993, Physician Orders for Life-Sustaining Treatment (POLST) is quickly growing in popularity and prevalence as a method of communicating the end-of-life care preferences for the seriously ill and frail nationwide. Early evidence has suggested significant advantages over advance directives and do-not-resuscitate/do-not-intubate documents both in accuracy and penetration within relevant populations. POLST also may contribute to the quality of end-of-life care administered. Although it was designed to be as clear as possible, unexpected challenges in the interpretation and use of POLST in the emergency department do exist. In this article, we will discuss the history,ethical considerations, legal issues, and emerging trends in the use of POLST documents as they apply to emergency medicine.