POLST Signature Requirements: Responding With Compassion While Ensuring Informed Consent.

Area of Science:

• Medical Ethics
• Palliative Care
• Patient Autonomy

Background:

• Physician Orders for Life-Sustaining Treatment (POLST) forms are crucial for end-of-life care decisions.
• Current state regulations often mandate surrogate decision-maker signatures on POLST forms for incapacitated patients.
• This requirement, intended to ensure informed consent, can impose significant emotional and spiritual burdens on surrogates.

Purpose of the Study:

• To evaluate the necessity and impact of mandatory surrogate signatures on POLST forms.
• To propose an alternative approach that upholds patient autonomy while mitigating surrogate distress.
• To advocate for a shift from required to recommended surrogate signatures.

Main Methods:

• Analysis of existing state regulations regarding POLST form completion.
• Ethical review of the implications of surrogate signatures on patient autonomy and surrogate well-being.
• Proposal of alternative procedural safeguards for informed consent.

Main Results:

• Surrogate signatures are neither sufficient nor necessary for valid informed consent on POLST forms.
• Mandatory signatures can exacerbate surrogate distress, misconstruing the document as a "death warrant".
• Alternative methods can effectively ensure informed consent and respect patient autonomy.

Conclusions:

• The requirement for surrogate signatures on POLST forms should be reconsidered.
• Recommending, rather than requiring, surrogate signatures can reduce emotional burden.
• Emphasizing healthcare professional attestation of informed verbal consent ensures patient autonomy without increasing surrogate distress.