What is a Physician Order for Life Sustaining Treatment (POLST), and is it appropriate for me?
A POLST is a physician order documented in a state specific form created and signed by your doctor, after conversations with you, that informs emergency care providers what kinds of treatments you want (and don’t want) in a medical emergency. In essence, a POLST has the same purpose as a Advanced Directive/Living Will (documenting your desires), but it also includes a physicians order and signature, which can carry more weight with an attending physician who is not familiar with you.
The POLST is also known as a Physician Orders for Scope of Treatment (POST), and may have different first initials based on the specific states for which they apply, such as COLST, MOLST, and MOST. For simplicity sake, we’ll refer to all of these as POLST’s. Note that states each have programs at various states of development, and can use the terms above for their programs, but they do not necessarily represent the POLST Paradigm (see more below) until they have been endorsed by the NPPTF.
POLST forms are like Do Not Resuscitate (DNR) orders in that they:
1) must be signed by a doctor and,
2) instruct emergency medical teams whether to administer cardiopulmonary resuscitation (CPR).
However, POLST forms cover many additional types of medical interventions, such as intubation, antibiotic use, and feeding tubes. If your doctor doesn’t already have a POLST form specific to your state, encourage them to get one here.
Since the POLST is an actual physician’s order resulting from a detailed discussion with your PCP, your attending physician may be less likely to interpret your specific circumstances as outside the explicit guidance within the POLST document itself. POLST’s do not generally include the appointment of an Advocate, Agent or Proxy (where many Advanced Directives do).
The National POLST paradigm is a combination of the POLST document itself as well as the conversations that lead up to it. It encompasses; ‘… an approach to advance care planning developed for patients with one or more serious illnesses or frailty. The POLST Paradigm is based on a conversation between you and your health care professional.
The POLST conversation is about:
(a) your specific disease, treatment options (including benefits and alternatives), and what will happen as the patient’s disease continues; and,
(b) your goals of care and values.
After the conversation, your health care professional will fill out a POLST form, marking what treatments you do or do not want at the end of your life. Since the POLST is a medical order, once your health care professional signs it, it means that your treatment wishes will be known and should be followed during a medical emergency.
Remember: We coach, support, educate, and empower. We illuminate options you may not have known you had. But we don't decide what's right for you in your unique circumstances; only you can do that. And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.