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Who should have a POLST in place?

Created date

June 3rd, 2014

Maintaining our independence and making personal health care decisions are among our most cherished freedoms. For the majority of our lives we take this ability for granted, but what if we suffer injury or illness and cannot represent ourselves? How can we ensure that our wishes will be followed? 

The answer is simple—we need to prepare advanced directives that provide instructions on how we would like to be cared for should we become unable to make decisions. 

The two primary types of advanced directives you may be familiar with are health care power of attorney and living will. A health care power of attorney is a broad document and allows you to designate a trusted individual who can effectively stand in your shoes and make any health care decisions if you are compromised. A living will, on the other hand, is limited to giving specific instructions about medical treatment if you are terminally ill or in an end-stage condition. Recently, a third very helpful advanced directive option has been added, known as the Physician Orders for Life-Sustaining Treatment, or POLST.

What it means

POLST forms (or as they are known in some states, MOLST, COLST, MOST, or POST) are a helpful supplement to health care agency and living wills. They are designed primarily for people with serious illness or frailty, and they translate your wishes into standing medical orders that are available at all times. The form itself is a set of orders completed with and signed by your physician. Types of treatment typically addressed by POLST include cardiopulmonary resuscitation; administration of IV fluids and antibiotics; and use of mechanical ventilation and artificial nutrition. They may also address facility transfers, dialysis, and medical evaluations. 

The POLST form fills in a challenging gap that we often face in making clinical decisions with health care agents. All too often, health care agents struggle with what to do because they never had the detailed, difficult conversation about care wishes should catastrophe strike. POLST addresses many of these issues topic by topic, and together with appointment of a health care agent, represents a solid advanced directives package.

POLSTs can be especially beneficial in directing the actions of first responders. By law in most states, paramedics and emergency medical technicians have to administer life-sustaining treatments regardless of the presence of a living will. On the other hand, a POLST that specifies no CPR or other emergency procedures must be honored. POLSTs are easily transferrable from setting to setting (e.g., from a hospital to a long-term care facility) and are often printed on brightly colored forms so they are easily located. 

You and your doctor can decide if a POLST is appropriate for your situation. POLST forms are operational in 15 states and being developed in 28 more (visit polst.org for more information). While preparing advanced directives can be stressful, they will ultimately bring peace of mind to you and your entire family.

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