Max Millis, shown with his wife, Suzanne, after golfing in 2002, died in 2007 after he collapsed on a golf course from heart failure. He had written out a clear directive stating that he did not want advanced measures taken to revive him at the end of his life, that he preferred to die naturally, but despite Suzanne arriving on scene with the form, EMS continued to perform CPR and his wishes were unheeded, according to Suzanne Millis.(Photo: USA TODAY)
(USA TODAY) -- When Suzanne Millis arrived at the Oregon golf course on Mother's Day 2007,
she saw an ambulance on the green and a group of paramedics performing CPR on
her 80-year-old husband, Max Millis.
Tubes covered his body. Curious onlookers filled a nearby veranda.
"It was a train wreck," Millis said. "Max would have hated
Doctors diagnosed Max with aortic stenosis in 1999, but he chose not to seek
treatment, Millis said. She carried his advance directive with her, as
documentation of his wishes to die without aggressive medical intervention.
Despite that precaution, paramedics refused to stop performing CPR, even
after 15 minutes of failed attempts to revive Max's vital signs, Millis said.
Doctors later pronounced Max dead at the hospital.
Millis' story illustrates why legislators and advocates in a growing number
of states are promoting an end-of-life document they believe will improve the
medical treatment of patients who cannot communicate their wishes.
The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm, which
takes a step beyond an advance directive by creating medical orders based on a
patient's wishes for end-of-life treatment, also has critics, who say it is too
susceptible to abuse.
The POLST form is more detailed than a DNR (Do Not Resuscitate) form. It
includes directions regarding resuscitation, hospitalization, use of
antibiotics and intubation, and is signed by a doctor or other authorized
Indiana and Nevada are the most recent states to pass POLST legislation, in
May and June of this year, respectively. But In April, the disability-rights
advocacy group Second Thoughts Connecticut successfully lobbied against
Connecticut's effort to enact POLST legislation.
The National POLST Paradigm Task Force Initiative has endorsed POLST
programs in 16 states, with dozens more in some phase of program development,
according to the group's website. The original POLST program was created in
Oregon during the early 1990s.
"The whole purpose of creating the program was to create portable
orders that would move reliably from one place to another," said Susan
Tolle, co-developer of the original Oregon POLST program, and director of the
Center for Ethics in Health Care at Oregon Health & Science University.
"It took about 10 years to have widespread use of POLST in Oregon in
the 1990s," she said. "It has taken California only about three years
to have widespread use of POLST beginning in 2009."
The program's expansion has not been universal. Delaware's Division of
Public Health issued a statement in November asking medical providers to
refrain from using the state's version of the POLST form.
POLST forms are supposed to be filled out for terminally ill patients, but
reports had surfaced that Delaware health care providers were using the forms
for non-terminally ill patients as well, according to the statement.
Cathy Ludlum, one of Second Thoughts Connecticut's leaders, said the POLST
program may seem to increase patient options at first, but it actually limits
those options by steering elderly people and people with disabilities toward
"The doctors having these conversations, the training materials ... are
biased against treatment," she said. "This needs to be looked at with
a more critical eye."
Sara Buscher, who used to be a member of the pro-POLST organization Fox
Valley Coalition for End-of-Life Care, said she now believes POLST "is
grossly bad for many people."
POLST is oversimplified and its check boxes do not sufficiently cover complex
medical situations, she said.
"If you can't make your own decisions, you need to appoint a proxy who
knows you well and can make health care decisions for you that reflect what you
would want" instead, Buscher said.
A statement on POLST from the Minnesota Catholic Conference includes the
concern that forms can be used for patients who are not terminally ill as a
form of assisted suicide or euthanasia.
"This risk is too great to be acceptable," their statement says.
Tolle said fears stem from a basic misunderstanding of the program.
"It's like a medical interpreter taking the patient's values and
putting them into language that providers across settings can understand and
follow," she said.
Jon Keyserling, senior vice president of the National Hospice and Palliative
Care Organization's Office of Health Policy and Counsel, said POLST lends more
"credence and is more likely to be followed" during an end-of-life
scenario than previous documents.
Big stakeholders, including the American Hospital Association and AARP, have
joined hospice in support of POLST programs.
John Carney, president and CEO for the Center for Practical Bioethics, said
he rejects the notion that the public needs to fear its physicians.
"I really bristle at the notion that doctors are trying to end
lives," he said. "Where is the evidence of that? This form is written
in English, not in legalese or medical jargon."
Brittany Hargrave, USA TODAY