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Re "Care at the End of Life" (editorial, Nov. 25):
As a registered nurse with five years' experience treating cancer patients — some at the end of life — I believe that medical orders signed by a doctor, known as Physician Orders for Life-Sustaining Treatment, are invaluable. Because they are actual physician orders as opposed to declared wishes (as a living will is), they are standardized and can be followed by any health care facility in a given state.
This does two things: First, it makes it less likely that patients will have unnecessary, unwanted and possibly uncomfortable tests; second, it lifts the burden of medical decision-making from families during a very stressful period, allowing them to spend meaningful time with their loved ones without the additional stress of having to make these difficult choices.
Additionally, these orders are not set in stone: the patients or their chosen representatives may make changes to the orders at any time if they wish.
CAROLYN CONLEY
Pittsburgh, Nov. 25, 2012
To the Editor:
My father, Alan Abraham Kay, passed away a month ago because of complications from metastatic lung cancer. He battled the disease valiantly and successfully for two and a half years, always telling his family and friends that he had complete confidence in his "team" of doctors at N.Y.U.'s cancer center.
At the end of October, when it became clear that the battle was futile, that same team, together with palliative care specialists, helped him make his own decisions about how the end would go.
Because he was allowed to call the shots, because, when given all the information, he alone chose the circumstances of his death, the end of his life was as loving, as dignified and as human as he was.
We are so grateful that my dad was spared the suffering that no one should have to endure unwillingly.
ADINA KAY-GROSS
Port Washington, N.Y., Nov. 26, 2012
To the Editor:
Your editorial highlights the benefits of end-of-life planning tools like advance directives and Physician Orders for Life-Sustaining Treatment and the savings that result when patients' wishes are honored.
It is unconscionable that Catholic bishops in Wisconsin used fear tactics to thwart the adoption of POLST protocols. By blurring medical and legal lines with their religious doctrine, the Catholic bishops deny dying patients the ability to make difficult medical decisions based on their own deeply held values and beliefs.
No one should be forced by government or religious institutions to endure invasive treatment against their wishes. Sadly, the health system rewards doctors and hospitals even when they ignore patients' wishes by paying for treatments that patients explicitly reject.
Unwanted medical treatment that conflicts with patients' wishes should be deemed "medically unnecessary" and ineligible for reimbursement. Once providers realize that the excessive and painful treatments they force on dying patients won't be reimbursed, then advance care planning will attain real power and authority.
THERESA M. CONNOR
Washington, Nov. 26, 2012
The writer is director of government affairs for Compassion and Choices.
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