13.5 Dying Well is Social Justice
Kimberly Puttman and Patricia Antoine
As we look at the complex issues related to death and dying, we see that the question of who dies when is complicated by privilege, oppression, and difference. At the same time, we are capable of taking interdependent action to increase social justice for people who are dying and their families. We already talked about the community actions of death cafes and conscious communities. We discussed changes in the laws related to the end of life and right to life. In this section, we learn about three additional ways that people are taking interdependent action: POLSTs and Advance Directives, Green Burials, and Last Words.
POLST and Advance Directives
| POLST | Advance Directive |
|---|---|
| Medical Order to a doctor | Legal document |
| A health care professional completes the form | An individual completes the form |
| Is a specific Medical Order | Contains general wishes about treatment |
| A copy is in the patient’s medical record | May not be in the patient’s medical record |
| Was created in 1990 by Oregon Health and Sciences University | Began in 1967, as part of a living will |
| Oregon POLST | Sample Advance Directive |
The state of Oregon is once again an innovator. In the early 1990s, healthcare professionals and the state legislature created the POLST or Portable Orders for Life-Sustaining Treatment®. The POLST allows patients to describe what measures they want doctors to use to sustain their lives. These orders are really useful when patients are too sick to speak for themselves.
The POLST form is in addition to an advanced directive, a legal document that states a person’s wishes about receiving medical care if that person is no longer able to make medical decisions because of a serious illness or injury. An advance directive may also give a person (such as a spouse, relative, or friend) the authority to make medical decisions for another person when that person can no longer make decisions. Unlike an advance directive, the POLST focuses on what a doctor can or cannot do for the patient, including providing CPR or assistance with breathing.
The POLST process is now widely used in all US states, although state regulations vary (National POLST N.d.). To learn more about one family’s experience with POLST, the video POLST: When is the Right Time? [YouTube] is helpful.
Green Burial
In Chapter 8, we looked at some of the ways that environmentalists are acting to heal the earth. These efforts don’t stop with living people. They continue until after death. In the United States, until the 1930s, most people died at home. Their loved ones took care of their body. They were buried in home or city-owned cemeteries.
After this time, however, many states required trained morticians to report the deaths, embalm the bodies, and bury them in cemeteries with caskets. Often, these caskets were covered in cement, preventing the normal decay of the body.This style of burial adds toxic