By Burke Balch, JD, Director, Robert Powell Center for Medical Ethics
Pro-life Oklahoma Governor Mary Fallin has signed into law HB 3017, a bill championed by Oklahomans For Life that will replace a widely circulated “Physician Orders for Life-Sustaining Treatment” (POLST) form that nudged people to reject life-saving treatment. It substitutes a neutrally-phrased document that ensures informed consent and embodies a presumption for life.
Starting in 1991 in Oregon (the first state to legalize physician-assisted suicide), and spreading to many other states in recent years, certain medical groups have created and sought to institutionalize use of these forms. They are now beginning to lobby Congress to impose a uniform POLST nationwide.
The central POLST concept is to have a one-sheet medical order form, with standardized wording and a series of checkoffs to give directions for such things as whether or not to provide resuscitation, antibiotics, food and fluids, and specific levels of general medical care.
Unlike an advance directive, which is a general expression of the patient’s wishes to guide health care decisions should the patient become incapable of making health care decisions in the future, a POLST is immediately effective and applies whether the patient is presently capable or incapable of making health care decisions.
Like the Oklahoma version previously created by a self-appointed, extra-legal “task force” which the new law will replace, many POLST forms contain misleading or biased language that subtly pushes those executing them to accept the denial of treatment, food and fluids necessary to save their lives. Rejecting life-saving resuscitation is described by the sugar-coated euphemism “allowing natural death.” Providing medically assisted food and fluids is stigmatized as “artificial.” Often, the alternative that most drastically rejects treatment is listed first – implying that it should be the assumed, standard, default position.
The new law, which pro-life advocates hope will prove a model for other states, limits the use in Oklahoma of out-of-state POLST forms that lack the safeguards and protection from anti-life bias which the new statutory form ensures.
Oklahomans For Life State Chairman (and National Right to Life Vice President) Tony Lauinger hailed the action of the legislature and the Governor:
“This new law is especially important in a culture which is increasingly trending toward denial of life-preserving care to vulnerable individuals who are elderly, infirm, or disabled on the grounds that such persons are a ‘burden’ or have a ‘poor quality of life.’ ”