Advance care planning helps individuals make decisions about future medical treatment, especially when facing serious illness or frailty. These discussions ensure a person’s values and wishes guide the care they receive, even if they become unable to communicate. A key tool in this planning is a standardized, actionable document that translates preferences into immediate medical instructions. This document is the Physician Orders for Life-Sustaining Treatment, commonly known as POLST.
Defining the POLST Acronym and Its Scope
POLST stands for Physician Orders for Life-Sustaining Treatment. It is a specific, portable medical order designed for patients with serious illnesses or advanced frailty—those for whom a clinician would not be surprised if they died within the next year. Unlike a general statement of wishes, the POLST form is a set of instructions that healthcare providers must follow immediately.
The document is formally signed by a licensed healthcare professional (such as a physician, physician assistant, or nurse practitioner) and the patient or their legally recognized surrogate decision-maker. The professional’s signature transforms the patient’s preferences into a binding medical order that must be honored across various care settings. While POLST is the common name, specific state programs may use variations like MOLST (Medical Orders for Life-Sustaining Treatment) or POST (Provider Orders for Scope of Treatment). The form’s authority is rooted in state-specific law, but the core purpose remains the same.
Specific Medical Treatments Addressed
The POLST form is highly focused, presenting concrete, binary choices regarding life-sustaining interventions that require immediate medical action during a crisis.
The first section addresses cardiopulmonary resuscitation (CPR) status, requiring a choice between “Attempt Resuscitation/CPR” or “Do Not Attempt Resuscitation/DNR” if the patient’s heart and breathing stop. The next section details the preferred level of medical intervention when the patient still has a pulse and is breathing. This choice ranges from “Full Treatment” (including intensive care and mechanical ventilation) to “Limited Additional Interventions” or “Comfort Measures Only.”
Another element involves decisions about artificially administered nutrition, such as feeding tubes. Patients or their surrogates must specify whether they desire long-term artificial nutrition, a trial period, or no artificial nutrition. By making these choices explicit on the form, the document becomes an immediately actionable set of medical orders for all treating clinicians.
How POLST Differs from an Advance Directive
The POLST form is often confused with an Advance Directive, but they serve distinct purposes and have different legal statuses. An Advance Directive, which includes a Living Will and the designation of a healthcare power of attorney, is a legal document stating general wishes for future care and recommending a surrogate decision-maker. It is recommended for every adult.
In contrast, a POLST is a set of medical orders intended only for individuals with serious, life-limiting conditions. The Advance Directive names who speaks for the patient if they are incapacitated, while the POLST states what specific care they want or do not want. Furthermore, an Advance Directive takes effect only when the patient is unable to communicate, but a POLST is effective immediately upon signing by the patient and provider.
The POLST carries the weight of a medical order, meaning healthcare providers are legally required to follow its instructions. An Advance Directive is a directive from the patient, not a direct order that Emergency Medical Services (EMS) personnel are trained to follow in the field. The POLST translates general preferences into specific, portable, and immediately executable medical instructions.
Practical Application in Emergency Settings
The primary benefit of the POLST form is its portability and immediate recognition by first responders and healthcare facilities. To ensure immediate action, the form is often printed on brightly colored paper, such as pink or green. Patients are advised to keep it in a highly visible location, such as on the refrigerator or near the bedside, helping EMS personnel quickly locate and act on the treatment preferences during a crisis.
EMS personnel are trained to follow the medical orders specified on a valid POLST form immediately upon presentation. This allows them to provide or withhold life-sustaining treatment according to the patient’s documented choices before transporting them to a hospital. Once admitted, the POLST orders are transferred into the patient’s medical record to ensure continuity of care.
The acceptance and specific rules for a POLST form can vary when crossing state lines. Although many states recognize forms from other jurisdictions, the document’s legal authority is governed by the local state law where the care is provided. Patients who travel frequently or move should confirm the local validity of their POLST and may need to complete a new form to ensure their wishes are honored.