Physician Orders for Life-Sustaining Treatment and Emergency Medicine: Ethical Considerations, Legal Issues, and Emerging Trends

Do not attempt resuscitation order in Japan

“…In all aspects of EOL care, there are frequent reports of differing opinions among medical personnel on the extent of treatment that should be provided to patients,6, 17, 18 as well as the need for EOL care education and training 19, 20. To prevent this type of confusion, the Physician Orders for Life‐Sustaining Treatment paradigm established in the USA clearly specifies the patient's wishes and prescribes the extent of treatment to be provided, and has proven effective in eliminating this confusion in health‐care settings 21, 22. Another disadvantage of DNAR issues identified in the responses was that health‐care providers outside the hospital (such as paramedics or ambulance staff) were performing CPR on patients who had gone into cardiac arrest while at home (4%; 4/94 hospitals).…”

Promoting dignified end-of-life care in the emergency department: A qualitative study

“…In a technological environment, patients, family members and professionals face palliative sedation, futility of treatment [7] and the physician orders for life-sustaining treatment (POLST) [26,27]. The preservation of a dying person's dignity in the ED is fundamental for the patient, his/her relatives and healthcare professionals [28].…”

“…(2014) [26] where most physicians in the ED consider that helping someone to die in conditions of comfort, dignity and respect is one of the most gratifying clinical experiences. Likewise, nurses feel that providing dignifying care could alleviate not only their own distress, but also that of the family and patient [7].…”

“…In other studies, physicians and nurses in the ED have expressed the need for specialized training (Pretorius et al, 2015) [10,26,31] for example, to know when to move on from a healing treatment to palliative care [3], how to effectively implement physician orders for life-sustaining treatment [26] or how to relieve pain and distress by administering opioids and other medication (e.g. IV paracetamol, anti-emetics, muscle relaxants etc.)…”

Resuscitating End-of-Life Care

“…13 We need to increase uptake of this essential communication tool. 14,15 Substantive conversations with patients about their mortality are difficult for physicians and, when the prognosis is poor, are likely to be perceived by patients as lacking compassion. 16 Recent approval of a Medicare plan to reimburse discussions about end-of-life care should help physicians find the time to engage in these important conversations.…”