Medicine is ever-changing. Advancements occur regularly. From the management of numerous disease states to high-tech wizardry such as robotic arms that can excise pathologies of microscopic proportions, to the mapping of the human genome; we have entered an unprecedented time in history.
Let us not forget, however, that the most central part of all of medicine is the human being - us. For all of the bells and whistles, wizardry and gadgetry, there remains only one true certainty - that all of us, regardless of gender, race, orientation, occupation, economics, political beliefs, religious affiliation, right-handed or left-handed, chocolate-loving or vanilla-loving, living on this side or that side of the tracks, desire some level of control over our own destinies. What is it that we hope for? What is it we fear? How do we want to live, love, laugh, cry in the face of possible unfortunate medical conditions?
I have been asked to provide commentary on a new medical document in Iowa. As of July 1, 2012, the IPOST - Iowa Physician Order for Scope of Treatment - form became a legal document that is intended to be utilized by individuals with serious medical conditions. Similar forms have been in use by numerous other states for several years. Here I will attempt to define the IPOST and its relation to other, more familiar, medical legal entities - the Living Will and Durable Power of Attorney, also called an Advance Directive. Simply put however, it is a tool by which we can help define our own destinies if faced with serious medical illness. At some level it can give us control in a seemingly uncontrollable situation.
Every competent adult needs to have both a Living Will and a DPOA. Be aware, the IPOST I am speaking about does not replace these documents. Living Wills are for the tragic accidents that none of us can predict (and hope never happen) but leave us so badly injured or ill that we cannot express our preferences for treatment. They are also important for discontinuing treatment at the end of a life-limiting illness. They help family and health care providers make informed decisions about your care. That is when your Living Will is needed, to guide your family in making treatment decisions. (Make sure you discuss your wishes with family and significant others in your life and that they know where it is located.)
Unfortunately, Living Wills are not strong legal documents and are frequently ignored. What you need in addition is a DPOA for health care that names someone as your "proxy" or substitute decision maker, such as a spouse, adult child or friend, to make health care decisions when you cannot and also to make sure your wishes are carried out. Again, be sure to have the discussions with the person you choose so that they understand the importance of honoring you wishes.
If you have a serious medical condition, a Living Will does not help when you call 911. Emergency personnel can only honor a doctor's order, and a Living Will is not a doctor's order. Instead, emergency personnel's job is to stabilize you and rush you to a hospital. At that time a search is begun to find someone authorized to make decisions for you. The IPOST form however can provide intervention instructions to emergency personnel.
IPOST is intended for people with a serious medical condition. To be valid, a physician, nurse practitioner or physician's assistant must sign it, allowing you to tailor your care to your particular illness. In addition, the IPOST form is portable, meaning it goes with you from nursing home to hospital to home. Because of its bright salmon color, emergency personnel identify it immediately and follow its directions.
If you become incompetent before signing an IPOST, the person you named as your proxy (in the DPOA) can sign it for you thus assuring that no matter how sick you are, your wishes will be honored.
There is also a proactive way to use the IPOST. When you are healthy, I recommend you fill out an IPOST form as though you are preparing for a worst case scenario, such as a major stroke or car accident and ask your physician to sign it. Then put it away, making sure your health care proxy and family know where it is. It won't become effective until it is presented, meaning life-supporting measures will be available to you until then.
When documenting your directives/wishes it is important to remember not to be hasty. There are times when cardiopulmonary resuscitation - CPR - and aggressive treatments are needed to get people back on their feet. Preventing treatment in those situations would be foolish. The purpose of these forms is to let you have a say when it is no longer an option - to empower you to have control over your life.
If you are interested in learning more about IPOST and the benefits of completing the form, please contact the IPOST office at Trinity Regional Medical Center at 574-6428 or email Phil Somsen, IPOST chairperson, at firstname.lastname@example.org.
Dr. Timothy Ihrig is director of palliative care at Trinity Regional Medical Center.