Getting the medical care you want and need near the end of your life can be tricky. You may want your life extended by whatever means possible and no matter whether you are conscious or unconscious, or you may wish to not be resuscitated if you have a terminal illness and you go into cardiac or respiratory arrest. And your family and/or your medical provider may or may not agree with your end-of-life medical care choices.
So what can you do to make sure your wishes are carried out? One piece of your end-of-life care arrangements could involve what is often called Physician Orders for Life-Sustaining Treatment, or POLST.
What is a POLST?
POLST is a streamlined way of making sure your medical care providers know exactly what end-of-life choices you have made. The aim is to make it much more likely that your wishes are carried out.
When you are dealing with medical power of attorney, possible family disputes, emergency services, and transfers to other medical facilities, sometimes your carefully planned decisions laid forth in a medical power of attorney or advance directive get set aside or disregarded.
Having a POLST in place will help the medical professionals involved in your care stay informed and make it more likely that your wishes are followed.
POLST does not replace an advance directive—they work hand in hand. The preferences that you set forth in an advance directive are used to fill out a form that makes it easy for any medical provider to see the choices you have made. POLST is literally medical orders to the doctors and other providers attending to you and is usually
A POLST by any other name
Most states have some version of this, but it has different names in different states. In general, however, when speaking of this type of framework for physician orders, it is just referred to as POLST. Some other names, plus a number of others, include:
- MOLST (Medical Orders for Life-Sustaining Treatment)
- MOST (Medical Orders on Scope of Treatment)
- POST (Physician Orders for Scope of Treatment)
- TPOPP (Transportable Physician Orders for Patient Preference)
- TOPP (Transportable Orders for Patient Preferences)
- COLST (Clinician Order for Life-Sustaining Treatment)
- SAPO (State Authorized Portable Orders)
- SMOST (Summary of Physician Orders for Scope of Treatment)
The name does not matter as much as the function of the orders. There are some differences between states, and a handful of states that do not have a robust program in place, but largely the form functions the same, despite the name differences.
There are a few other differences that are worth mentioning. States have a few differing requirements and benefits. Some states are required to offer a POLST if you are terminally ill and are expected to live less than 5 years. Some states have a state registry for you to file the POLST. Some states require you to sign it, but other states do not. Some states allow your agent or proxy to sign it, and others do not.
What does it include?
A POLST includes specific orders for your medical providers to follow in different situations. It is most appropriate at the end of life or when you are diagnosed with terminal illness and would know some treatment specifics. The instructions in a POLST are usually more specific than advance directive, and the POLST is generally signed by you and your physician and displayed in a prominent place.
A POLST can include:
- Intubation (feeding tube)
- Mechanical/artificial ventilation
- Antibiotic usage
- Pain medication
- Requests to not be transferred to emergency care or to not be admitted to a hospital
How do I decide what to include in the POLST?
Your medical care provider and perhaps some close family members are best positioned to help you decide what you want your end-of-life care to look like. Your physician can make recommendations based on their knowledge of your condition and explain what various options can do to help you prolong your life or provide maximum comfort.
How does the doctor find my POLST?
The POLST is part of your medical record, and also part of a state POLST registry in some select states. After it is signed, it should be displayed in a prominent position in your care facility room or in your residence.
Is it the same as an advance directive?
No. But a POLST and advance directives are both an important part of end-of-life planning, especially if you have a terminal illness or other conditions that you anticipate will require critical care.
An advance directive can be drafted whenever you like, even if you are still young and in good health. A POLST is reserved for when you are seriously ill or frail or clearly close to the end of your life. An advance directive usually includes more general preferences while a POLST includes very specific directions to your medical providers.
One big difference is that even if you have DNR (Do Not Resuscitate) orders as part of your advance directive, if you go into cardiac arrest and someone calls EMS, they generally will not pause to see if you have a DNR—they’ll provide immediate assistance when they arrive. With a POLST you have medical orders that give specific directions even to EMS.
Also, a POLST does not include a medical power of attorney, or specifying someone who can make medical decisions for you if you become incapacitate, even though in a number of states, your agent can sign a POLST on your behalf. Naming the agent would be part of an advance directive.
Not a legal document
Another big different between POLST and an advance directive is that it is not a legal document. It is simply an order signed by your physician giving specific instructions to other medical providers on your end-of-life care.
Can I change it once I have one?
Yes, you may change it or cancel it at any time. In many states, even If you become incapacitated, your power of attorney agent/medical power of attorney can change it for you.
You should change it (and possibly your advance directive(s) as well) if you change your mind about any of the preferences you specified, of course.
You may also need to have a new POLST signed if you move to another state or are transferred to a care facility in another state. Some states accept a POLST from another state, but some states do not, and in a number of states it is unclear if a POLST from another state should be valid.