OPEN LETTER: Now is the Time

Apr 2020

Dear Editor,

I am a geriatric physician in New Jersey. Like everyone during this COVID-19 crisis, I’m troubled by the shortages in resources and the difficult decisions our healthcare teams may soon be facing.

I know many of us are feeling anxious by the uncertainty of it all. It’s impossible to plan for everything. But, we can help manage life’s unknowns by talking openly, especially about what matters most to us and what we’d want if we became seriously ill with coronavirus. Caregivers may need to make decisions for us and we can’t assume they know what we would want. If we don’t say it, they won’t know it. Open conversations can provide clarity and comfort and may help to alleviate some of the stress associated with making decisions in the midst of a health crisis.

All adults should have an advance directive to identify a surrogate decision-maker and provide information about treatments they may or may not want in an emergency. However, for high-risk patients, including frail elders and patients who become seriously ill and are at risk for a life-threatening clinical event, a POLST (Practitioner Order for Life Sustaining Treatment) form may be appropriate.

POLST is a medical order and directs doctors by offering specific instructions related to a patient’s personal goals of care, artificial nutrition, resuscitation and re-hospitalization. I strongly encourage family decision-makers and authorized healthcare proxies for people living in nursing homes or other long-term care facilities to speak with their loved ones, when possible, to make decisions about future medical care, and to put them in writing.

GOCCNJ is helping to educate the elderly, nursing home residents, their loved ones, and their authorized healthcare proxies about the importance of discussing and documenting wishes for medical care in either an advance directive or POLST. GOCCNJ will lead a daily M-F, 30-minute Zoom webinar at 1:00 PM EST through April 24th. Visit to register for the webinar and access free tools and resources about COVID-19 and the advance care planning process.

It is always better to make plans for future medical care before a medical emergency. As we are living in an unprecedented time, NOW is the time to discuss, decide and document your wishes for medical care. Please, help our medical staff offer heroic interventions to those who wish to have it, so we don’t burden those who wish to avoid it.

Stay safe.

David Barile, MD
Director of Palliative Medicine Services and Medical Director of the Acute Care for the Elderly Unit at Penn Medicine Princeton Medical Center Founder and Chief Medical Officer, Goals of Care Coalition of New Jersey