The Intent of the Physician's Order for Life-Sustaining Treatment: Reflecting Patient Wishes and Institutional Obligations.

Abstract

Portable Medical Orders (PMO) such as the Physician's Order for Life-Sustaining Treatment and the Medical Order for Life-Sustaining Treatment have proven to be valuable documents that allow patients who are medically frail or have life-limiting illnesses to communicate their health care wishes. Because these documents are in the form of a Physician's Order that can travel across multiple health care settings, they offer a form of certainty and reassurance for the patient that their wishes will be respected. The PMO depends on a conversation between the trained health care provider and the patient or their designee. The PMO functions as a legal document, communicating medical orders that must be followed and providing clinicians who do so with legal protection. The choices within (including resuscitation, treatment choices, and artificial feeding) must be understood by the patient in association with their own prognosis and health care status; the signatures within the form attest that a discussion of those choices has taken place and the patient understands not only their choices, but also the implications of them. A PMO with incomplete signatures is not a valid legal document. In the scenario presented here, the author discusses a scenario in which the discussions did not take place and the signatures are questionable, leading the patient to receive aggressive medical treatment that might not be in their best interests. The reasons behind the above ethical issues are related to a misconception and misuse of the PMO within a long-term care facility. Unfortunately, as noted in the literature cited and in the author's own experience, these ethical issues are not uncommon.