Oregon's end-of-life medical directive form, or POLST form, will no longer include the option of having a feeding tube.
Feeding tubes are surgically inserted through the abdomen wall and deliver food. Doctors say they work well for patients in a coma or living with a condition like Lou Gehrig’s disease.
But Dr. Susan Tolle with Oregon Health & Science University's Center for Ethics In Health Care, said research shows the tubes can be harmful for people with dementia. They tend to increase discomfort and agitation, she says, and that can lead to the use of restraints and as a result, bedsores.
The new 2019 POLST form does not include the use of feeding tubes.
OHSU
“We are seeing more confusion and conflict and having families think they are something that are an option, when they will not extend life,” said Tolle.
The American Geriatrics Society does not recommend feeding tubes for older adults with advanced dementia.
The end-of-life or ’POLST’ form, allows dying people to dictate their care. For example, asking for comfort care only in the event of an emergency — instead of invasive medical procedures to prolong life.
The POLST form was created after a group of ethics leaders, convened by OHSU, to ensure the end-of-life health care wishes of those with advanced illness or frailty would be followed. POLST-like programs have been adopted or are in development in all 50 states and Washington, D.C., and are associated with reducing unwanted hospitalizations near the end of life for patients whose forms call for comfort-focused care.
Separate from POLST, advanced directive forms share a patient’s end-of-life philosophy and enable patients to appoint a surrogate, but they do not provide actionable medical orders for an emergency.