Individuals facing a serious illness or advanced frailty often have clear preferences about the types of life-sustaining medical interventions they wish to receive. Communicating these wishes effectively and ensuring they are honored across different care settings requires a specialized and immediate tool. The challenge lies in translating personal values and goals of care into instructions that every healthcare provider, including emergency personnel, can immediately understand and follow during a crisis. This need for clear, portable, and actionable medical instructions led to the creation of the POLST paradigm.
The Meaning and Purpose of POLST
POLST stands for Physician Orders for Life-Sustaining Treatment, though in some states, the acronym may represent Provider Orders for Life-Sustaining Treatment. The form’s central purpose is to translate a seriously ill or frail patient’s preferences into immediately actionable medical orders. Unlike a typical document of wishes, a POLST form is signed by an authorized healthcare professional, such as a physician, nurse practitioner, or physician assistant, giving it the authority of a prescription.
The document is intended for individuals at a higher risk of a life-threatening event, typically those whose medical condition suggests their death would not be unexpected within the next year or two. It is designed to be a portable set of instructions that travels with the patient, ensuring their wishes are known regardless of their location. Some states use similar variations of this medical order, including MOLST (Medical Orders for Life-Sustaining Treatment) or MOST (Medical Orders for Scope of Treatment).
By obtaining a provider’s signature, the patient’s choices regarding treatment intensity are converted into a legally recognized, mandatory medical order. This distinction allows emergency medical services (EMS) personnel to follow the instructions without needing to interpret broader, non-binding statements.
Key Medical Orders Contained in the Form
The POLST form addresses specific, life-sustaining medical treatments in detail, providing clear choices for emergency situations. The first section addresses Cardiopulmonary Resuscitation (CPR) status. A patient must indicate whether they want CPR attempted if their heart stops or they stop breathing (“Attempt Resuscitation”), or if they prefer a “Do Not Attempt Resuscitate” (DNAR) order.
A separate section outlines the desired level of medical intervention for a patient who still has a pulse and is breathing, offering a spectrum of care. The most comprehensive choice is “Full Treatment,” which includes intensive care, mechanical ventilation, and all other medically effective means to prolong life.
Another option is “Selective Treatment,” which includes general medical care, IV fluids, and antibiotics, but specifically excludes intubation and generally avoids intensive care. The most limited option is “Comfort Measures Only,” focusing entirely on pain and symptom management, with no use of life-prolonging measures.
Another area of the form addresses Artificially Administered Nutrition, specifying choices regarding the use of feeding tubes for long-term nutritional support. The document also provides a space to indicate preferences for other specific interventions, such as the use of mechanical ventilation or the administration of antibiotics.
Each section requires the patient or their legally recognized decision-maker to make a definitive choice after a thorough discussion with their healthcare provider about the potential outcomes. This process ensures the documented orders accurately reflect the patient’s goals of care given their current medical state. The specificity of these orders removes ambiguity during a medical emergency, guiding care providers on the exact treatments to be administered or withheld.
Distinguishing POLST from Advance Directives
A common point of confusion is the difference between a POLST form and traditional Advance Directives, such as a Living Will or a Durable Power of Attorney for Healthcare. The two tools serve distinct, though complementary, roles in advance care planning. Advance Directives are generally recommended for all adults, regardless of their current health condition, to state broad preferences and designate a healthcare agent to make decisions on their behalf.
In contrast, the POLST form is specifically intended for a limited population: individuals with a serious illness or advanced frailty. An Advance Directive usually becomes effective only when a patient is unable to communicate their wishes. The POLST, however, is a standing medical order that is effective immediately upon being signed by the patient and their provider.
The primary functional difference is one of authority and specificity. An Advance Directive is a legal document offering a set of general values and instructions that may require interpretation by the medical team. The POLST, because it is a medical order signed by a clinician, is highly specific and immediately actionable by any licensed healthcare professional, including EMS personnel.
A Living Will often states broad desires for future care, but a POLST form documents precise, portable orders for current life-sustaining treatments. The Advance Directive appoints who will speak for the patient and what their general values are, while the POLST form dictates what specific treatments must be provided or withheld in an emergency.
Implementation and Legal Status
The physical form is designed for maximum visibility and portability across all care settings. It is frequently printed on distinctively bright paper, such as pink or green cardstock, to ensure it is easily recognized by emergency personnel and not mistaken for other medical paperwork. This form is intended to travel with the patient, whether they are moving between facilities or residing at home.
Because the POLST is a medical order, healthcare providers are required to follow its instructions, with few exceptions. Emergency medical services (EMS) personnel are trained to recognize the form and are authorized to honor its directives regarding resuscitation and other immediate interventions in an out-of-hospital setting.
Though the form does not expire, it should be reviewed regularly, especially when there is a change in the patient’s health status or care goals. The POLST is a state-specific document. While the patient’s wishes should always be communicated, its legal binding nature may not be recognized if the patient travels across state lines. Patients who spend significant time in another state may need to complete that state’s equivalent form to ensure legal compliance.