Physician Orders for Life Sustaining Treatment (POLST) is a document that is created between a physician and a patient that outlines the care and treatments that a patient does and does not wish to receive. POLSTs are created based on the current health status of the patient.
The POLST takes into account the progression of the patient’s illness. Based upon their prognosis, the patient and their physician will determine which treatments the patient wishes to receive based on their personal preferences or religious beliefs.
Is POLST Different from an Advanced Directive?
Yes, the POLST is different from an advanced directive. Advanced directives are used to appoint health care representatives and to guide decisions for a patient’s future life-sustaining treatment.
Advanced directives are typically implemented ahead of any serious illnesses. POLST forms can supplement advanced directives, as they guide decisions regarding the current care and treatment of patients.
The significant differences between the two types of documents include:
- Age of patient: A POLST form can apply to a patient of any age, while an advanced directive applies to individuals who are over 18 years of age;
- Emergency care: POLST will apply in the case of treatment by emergency treatment, while an advanced directive will not;
- Appointment of an agent: Advanced directives will appoint an agent to make treatment decisions based on the patient’s wishes if they are not capable of doing so. A POLST does not appoint an agent, but can be created by the patient’s agent in consultation with a physician; and
- Type of treatment: Advanced directives typically provide guidance for life-sustaining care generally, while POLST forms cover more specific treatments that may be used. For example, a POLST may provide that the patient does not wish to receive antibiotics, while an advanced directive would not cover this issue.
In addition, a Do Not Resuscitate (DNR) order typically expresses a patient’s wishes to pass away naturally rather than to be given CPR or other life-saving treatments if their breathing or heart stops. POLST forms may also cover these types of issues but may also cover other methods of treatment as they have a broader scope.
In some situations, POLST forms are used in place of DNR orders.
Who Benefits from POLST?
The goal of POLST forms is to provide instructions for a patient’s care and treatment based upon their current medical condition. Because of this, they are recommended for individuals whose death would not be unexpected if it was to occur within 1 year.
POLST forms are commonly used for elderly or terminally ill patients who are receiving end-of-life care. Without a POLST form, health care providers will be required to perform all treatments necessary to sustain the patient’s life.
Will Doctors Respect My Treatment Preferences?
POLST forms typically outline a patient’s wishes for treatment on brightly colored paper. The instructions for their care must be obeyed by emergency personnel, including emergency medical technicians (EMTs) and paramedics.
In addition, any care that is provided following the emergency must comply with the POLST.
How Do I Create a POLST Form?
When an individual is admitted to a healthcare facility, they may be asked whether they wish to complete a POLST. The patet may also request one so long as their state recognizes POLST forms.
The patient’s physician or other healthcare professional will consult them or their appointed agent regarding their wishes and goals for their treatment based on their current prognosis. Together, the patient and their medical team can determine which treatments align with the patient’s wishes.
The availability of a POLST form depends on the state. The majority of states have a POLST program, although it may have a different name, such as:
- Physician Orders for Scope of Treatment (POST);
- Medical Orders for Life-Sustaining Treatment (MOLST);
- Transportable Physician Orders for Patient Preferences (TPOPP); or
- A list of programs available by state can be found at the National POLST Paradigm.
What if My State does not have a POLST program?
If an individual’s state does not have a POLST program, they can consult with an attorney to assist them in creating the best document for their needs. An attorney can help an individual create a:
What is a Living Will?
A living will is a type of advanced medical directive. It outlines to what extent an individual wishes to receive life-sustaining medical treatment in the event that they become incapacitated or seriously ill as well as under what circumstances they would want the physicians in charge of their treatment to forgo providing additional life-sustaining treatments.
A living will, in general, goes into effect when the individual who created it becomes incapable of making important healthcare decisions on their own, usually if they become incapacitated or unconscious.
Other types of advanced medical directives, including healthcare proxies, appoint another individual to make a wider variety of medical decisions on the patient’s behalf, whereas the scope of a living will is typically more narrow in scope and only addresses end-of-life care. In order to ensure that the patient’s wishes are honored, healthcare providers or any other individuals who knowingly violate a living will may be subject to legal consequences.
A living will will not be effective, however, if the patient does not inform their physicians or loved ones that they have a living will. The patient should also provide these individuals with a copy of the document to ensure it is followed.
What is a Power of Attorney?
Power of attorney is a legal arrangement where one individual is legally authorized to make legally-binding decisions for another individual. In some situations, a power of attorney can arise automatically.
For example, parents, in general, have power of attorney over their minor children. In addition, married individuals have power of attorney over their spouse if their spouse becomes incapacitated.
In some cases, however, it makes sense to grant power of attorney when it would not arise automatically. For example, it may be necessary in cases where an individual becomes unable to make legally-binding decisions on their own.
What Does Durable Power of Attorney Mean?
There are numerous different types of power of attorney arrangements. A durable power of attorney is a specific type which grants the most extensive decision-making powers.
A durable power of attorney remains in effect even if the principal becomes incapacitated. In general, an individual is deemed to be incapacitated when they are unable to make their own decisions due to:
Do I Need an Attorney to Create a POLST?
POLST forms are created between you and your healthcare team or physician. If, however, you have any questions regarding the document, its effectiveness, and its duration, it may be helpful to consult with an attorney.
If you have any questions or are unsure about the effect the POLST will have on your treatment, it may be helpful to consult with an attorney before formally signing the document. Your attorney can also help ensure that members of your healthcare team and your loved ones receive copies of your documents to ensure your wishes are honored.
In addition, if you want to create any other estate planning documents or documents that plan for your future medical treatment, it may be helpful to consult with an elder law attorney who can help you determine the best options for your situation.
