In the past few days, end-of-life care has been in the news with the story of an elderly woman’s death at a California independent living facility. A new article (available here) provides additional information about Lorraine Bayless’ death, including the fact that the patient did not want CPR and that she died of a massive stroke.
Key elements were missing in the original stories that aired nationally, including:
1. The original article inaccurately suggested that the patient was deprived of a treatment (CPR) from which she was likely to benefit. The article (and the audio tape that is available of the EMS call) suggested that her life would have been saved if the nurse had given her CPR. However, CPR is effective less than 8% of the time outside of a hospital setting. For an elderly patient with additional medical issues, the odds of success could have been far lower.
2. The original article failed to consider the possibility that the woman may not have wanted CPR. People have a right to refuse medical treatments that they do not want and to receive those they do. Many frail elders do not want CPR. We do not have specific data about the wishes of frail elders in retirement communities. However, we do have data about residents in nursing homes in 3 states (available here) and only about 12% of skilled nursing patients would want CPR and to go to intensive care and be placed on a ventilator. If Lorraine Bayless had received CPR and been in the small group that survived resuscitation she would have been placed on a ventilator in an intensive care unit and may or may not have been able to return to living independently in her apartment. From her family, we now know she did not want CPR.
This story demonstrates the importance of POLST programs. POLST programs allow those with advanced illness and frailty to make decisions about their treatment. Specifically, POLST programs allow patients to have the treatments they want and refuse those they do not want. The program makes the wishes of frail elders like Lorraine Bayless known and provides the medical orders to support elders’ decisions, no matter which choice they make.