POLST/ DNR ALERT--what insurers are pushing

Today I found myself in a meeting with family, nursing home leadership and insurance people about the care received by my friend in a nursing home I recommended. The nurse practitioner working through United Healthcare cut my friend G off from their care because he signed, then retracted, a DNR form that she worked hard to convince him to sign, even though he was adamantly opposed to DNR. When I found him an hour after this signing encounter, my friend, who had been suffering from medical illness but not in anyway terminal, felt being cast out, "She made me feel I am on my way already, that such a gory picture was given, that I should just forgo every treatment." When I explained that he has every right to undo what he signed if it made him uncomfortable and coerced, he voided the document the following day. On the third day, the nurse practitioner came and said they are relieving him from participating in the Optum program, claiming that he is not following treatment planning and he would require more resources than what they would like or can provide under their plan. When my friend was told of this change, he felt he was even pushed out further. To me, it smacks now, not only of an assisted suicide/euthanistic trend, but frank discrimination at the institutional level promoted by dubious cost-cutting desires of the insurance company. I asked her to provide me with the memo outlining to me their practices, if it indeed was the norm of United Healthcare to exclude from their sickest from their own preventive program that was supposed to curb hospitalization. The nurse practitioner walked out when I made this request, that I had to bring it up to the administrator of the facility, especially that my friend was extremely upset about how he was dialogued about his end-of-life options. I didn't plan on visiting him today, but when I was at church, the call came that I had to make my way there and ask for a meeting that would involve the administrator, my friend, and the nurse practitioner, with me in attendance. Sure enough, a meeting was already scheduled with even G's visiting family involved, so it only took Brian to tell them that he wanted me there as well.

End-of-life discussion will be fraught with a lot of confusion, mainly because of two things: it is so contaminated and embedded with euthanistic practices many in the health care community do not even know it, and thus advocate for it rabidly (partly because some have been legislated though this can be questioned and opposed still, of course); and secondly, Catholic patients do not know their best recourse because they have been unformed. Thankfully, Brian and his family are not of the second camp. G's brother, who is a doctor, knows fully well that G would never sign a DNR form for that is against every religious fiber of his being, and the fact that he signed it, he says, shows how much bias and hardselling the insurance people are driving patients to go against their religious beliefs. Dr. even added that his church had a talk on this issue recently so he knows how the form, POLST, can so easily be swayed towards the agenda sought by the insurers or providers, which is waiving of care that would still easily give a chance at life. But I saw it more deviously, if not a truly systematic deception at the insurance level, which trickles down to facilities at any tier of care. But I still gave the insurance people the benefit of the doubt, asking them for the company policy underlying this denial of care, which happened very suspiciously when a DNR was declined. Ultimately, they were unyielding and defiant that I have to bring it down harsh. I explained that this is among my field of study, part of my court-certified expertise and consulting for hospitals, state health departments and agencies; that this form is outlawed in Florida and Connecticut for its immoral content, and that even though the state recommends POLST, nowhere it is written that it is best practice, nor even evidence-based. I began to tell them the history of the form, which is really a subset of the living will, a Euthanasia Society of America desire from 1964 made into a more palatable and yet dangerous version by the Oregon Health Sciences folks in the 1990's, a living will, but something that the insurance people say gives them more juice, because in their words, "we need something actionable". What I said was actionable proves to be, for the most part, fear-driven and not even reasonable. For my friend was being driven to make a decision that he was not even finding himself in--say, terrible sickness that deprives him of capability--but has to project himself in the scenario that would make him balk at the agony and burden of care, as painted direly by the nurse practitioner (oh, tubes! oh, coma!) Yet, as I explained, and which the nursing home director affirmed in an example, when a patient finds himself at some new uncomfortable symptomatology, despite what he or she signed, one will seek to undo a limited care form and ask for the full care. That is, one, if the patient is lucky enought to be able to communicate. Two, if the facility/ provider is willing to make this amendment immediately and do enact the full care that anyone in their survival instinct mode will typically find themselves desiring. There was a point where I was getting talked over, the claims that no abuse ever happens and that it can easily be overriden when a patient asked for it, but seeing the national hospital and legislative trends, I said the nursing director was actually behaving as the exception than the rule. They may speak it is happening ethically in their facility because of that one instance, but they are also being blind to the fact that the change that my friend requested was met by what is a retaliatory jab for wanting full, rather than less care.

For all the insurance people's finesse, they speak quite frankly of excluding him from the preventive program for requiring more "aggressive care". My friend wheeled himself out of the meeting out of disgust. The insurance people still didn't get it--the mal/ poor practice from the template-driven rather than patient-centered care, the discrimination, the outright unethical roots of POLST (true, there is an option for checking one wants all care done, but the presentation is rarely neutral. In fact, it is a death warrant really, poorly explained and deliberately emptied of the giving of other options such as health care proxy, which would have been the most ethical and also most sane for Catholics especially. I added that ordinary means of care, such as antibiotics, food and water, feeding tubes for the above, which is itemized in the POLST, or other advance care should be favored, as it is natural for any living person, sick or well, to receive for health optimination (prevention of complications) and comfort. But DNR is so easy and cheap for insurers, they just default towards it and naturally forgo all other nuances of care. Take home: be informed that the POLST, no matter how well-meaning it is, is designed as a euthanistically inclined living will but with teeth, immediately enforceable and is hard to undo once signed, despite many good hopes by the promoters. It breeds laziness and withholding of care, even when it could still save a life. So don't participate in anything official that smacks of fear and despair, and you deprive yourself of commonsense supports and basic treatment that would spell the difference of more time on earth to fulfill your mission versus less.