As We Lie Dying

A Necessary Protocol for End-of-Life Care

We all die, and most of us understand that it is best to be prepared. Yet most of us remain woefully unprepared for life’s final transition. One way of addressing this problem is the Physician Orders for Life Sustaining Treatment (POLST) paradigm, which provides an opportunity for patients with advanced illness to understand their illness and their treatment options and to have their wishes for these options known and followed.

POLST is not without critics. Some criticisms address clear misuses of the paradigm—as when, for instance, the process fails to include face-to-face physician conversations with the patient, or when POLST is used for someone who is medically stable with a life expectancy of years. But others are more fundamental. Some critics, including some Catholic bishops, assert that POLST elevates patient autonomy to the level of an overarching, enforceable legal right, allowing patients to mandate nontreatment in a way that constitutes voluntary euthanasia. It is, of course, important to guard against opening any doors to euthanasia, but worries about...

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About the Author

Rev. Gerald Coleman is vice president for corporate ethics, Daughters of Charity Health System, and adjunct professor at Santa Clara University. Margaret R. McLean is associate director of the Markkula Center for Applied Ethics and a senior lecturer in Religious Studies at Santa Clara University.