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Making the final decision

By Jennie L. Phipps ·
Thursday, May 29, 2014
Posted: 3 pm ET

© Tyler Olson/
If end-of-life decision-making documents aren't yet part of your retirement planning, here's a reason to add them.

The 85-year-old mother of a friend of mine recently received a pacemaker while she was hospitalized with a broken leg. My friend, who is a registered nurse, says her mother has severe dementia and a host of other ailments that made extending her life artificially a decision that wasn't in her mother's best interests.

The decision to install the pacemaker fell to her father. When he asked my friend what she thought he should decide, she told him, "What I've seen as a nurse is that a pacemaker keeps a body alive -- not a person, but a body."

The enormity and consequences of the decision confused and troubled her father, and ultimately, he was unwilling to say no, so her mother got the life-extending pacemaker. If her mother had end-of-life decision-making documentation in place, the outcome might have been different.

Many states are adopting a new approach to end-of-life planning, known as Physician Orders for Life Sustaining Treatment, or POLST. This document emphasizes advance care-planning conversations between patients, their loved ones and health care professionals. It seeks to ensure that the patient's wishes are honored in future emergency situations. It differs from an advance directive because it focuses on unknown future occurrences rather than current treatment. It also guides medical personnel in an emergency, which advance directives generally don't do.

A POLST is a medical order and, therefore, must be completed and signed by a health care professional. A patient can't do this on his or her own. POLSTs are endorsed or developing in most states. They have been long established in Oregon and West Virginia. If the concept is available in your state and you would like to include one of these in your retirement planning, start by talking to your doctor.

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