Caring for your future

Form conveys wishes more clearly than advanced directives

A new document gives people at the end of their lives some say about the circumstances in which they die.

The Louisiana Physician Orders for Scope of Treatment (LaPost), once signed by the person and their physician, becomes an order that carries across all medical settings in the state.

“It’s another tool that patients now have to further their preferences ... patients and doctors are having a conversation about what that patient wants,” says Jamey Boudreaux, executive director of the Louisiana-Mississippi Hospice and Palliative Care Organization, based in New Orleans.

And, Boudreaux stresses, “the important thing is you let your family know you’re signing these ... The real importance of these documents is sharing the information with your spouse and children.”

With its status as physician’s orders, the LaPost document differs from other forms, such as advance directives that tell a person’s wishes for end-of-life care, and the health care power of attorney that names who will make medical decisions for someone when that person can’t.

There’s a good place for those documents, which can be made at any time in an adult’s life.

But an advance directive “still has to be interpreted by a physician and the patient or their family to be acted upon. It’s still vague,” says Dr. Susan Nelson, a geriatrician and chairwoman of the LaPost Coalition.

The LaPost document can be used by an adult in the midst of a sudden illness or a serious, advanced illness, when it’s highly probable, according to their doctor, that they will die in the next six months.

If a person lives longer than expected, the document is still valid. It can be changed or canceled at any time.

If someone is unable to fill out the document themselves, a family member can fill it out “based on what they know (the patient) wants,” Nelson says.

“The document is voluntary and is neither for or against treatment,” says Nelson. “What you hope is (patients) want control over the kinds of things that will and won’t happen to them.”

The LaPost document lets people state their preferences on CPR, medical interventions, antibiotics and artificially administered fluids and nutrition. There’s also a place for other instructions.

For any part of the document that isn’t checked off, the patient will receive the highest level of care for that particular treatment.

It’s recommended the LaPost document be printed on gold-colored paper so that it stands out among a person’s papers.

The Louisiana Health Care Quality Forum came up with the document after hurricanes Katrina and Rita, when a group called the Health Care Redesign Collaborative was convened in an effort to redesign the state’s health system.

“Those of us who take care of people who are older and sicker and in nursing homes (were looking for) how to make things better for them between today and when they die,” Nelson says.

The Louisiana Health Care Quality Forum is undertaking educational efforts across the state, one region at a time, to provide information about LaPost to health care professionals, hospitals and faith-based organizations.