The Physician Orders for Life-Sustaining Treatment, commonly known as a POLST form, is a standardized, portable medical order designed to summarize a patient’s specific wishes regarding end-of-life care. This document is intended for use by individuals who are seriously ill or medically frail, facing a health status where a clinician would not be surprised if they passed away within the next year or two. It translates a person’s generalized preferences into actionable medical instructions that healthcare providers must follow during a medical crisis and ensures treatment goals are honored across different care settings, from their home to an ambulance or hospital.
Defining the POLST Form and Its Function
The POLST form is fundamentally a medical order, meaning it carries the same weight as a prescription or any other order written by a licensed clinician. This status makes the document immediately enforceable, particularly by emergency medical services (EMS) personnel who often cannot honor other types of advance care documents. The form must be completed following a detailed conversation between the patient, or their legally recognized decision-maker, and a qualified healthcare professional, such as a physician, nurse practitioner, or physician assistant.
For the POLST to be valid, it requires a signature from both the patient or surrogate and the authorizing clinician. The document is often printed on distinctively colored paper, such as bright pink or green, to ensure it stands out and is immediately recognizable in a patient’s chart or home environment. This high visibility aids first responders in quickly locating and complying with the orders, preventing unwanted or non-beneficial treatments. The form is designed to be portable, traveling with the patient to ensure continuity of care.
Specific Medical Treatments Covered
The POLST form provides hyperspecific, actionable instructions across several categories of life-sustaining treatment. The first and most critical section addresses cardiopulmonary resuscitation (CPR) status, where the patient selects either “Attempt Resuscitation” or “Do Not Attempt Resuscitation” (DNR). This choice dictates the immediate response of medical personnel if the patient’s heart and breathing stop.
The form then details the patient’s desired Level of Medical Interventions for when they have a pulse and are breathing but are seriously ill. This section typically offers three distinct options: “Full Treatment,” which includes intensive care, mechanical ventilation, and other life-prolonging measures; “Limited Additional Interventions,” which permits medical treatments and IV fluids but excludes intubation; and “Comfort Measures Only.” The “Comfort Measures Only” choice constitutes a complete category of care focused solely on maximizing comfort and managing pain, using treatments like oral suction or oxygen, but explicitly avoiding life-prolonging interventions.
Further sections cover decisions regarding Artificial Nutrition, which allows the patient to specify whether they want long-term feeding tubes or prefer to be offered food and fluids by mouth. Another common section addresses the use of antibiotics, where choices often range from using them to prolong life to only using them for comfort care, or declining them altogether.
Distinguishing POLST from Advance Directives
While both POLST and Advance Directives are part of advance care planning, they serve different populations and functions. Advance Directives, such as a Living Will or Durable Power of Attorney for Healthcare, are legal documents recommended for all adults to outline general treatment wishes and appoint a healthcare agent. In contrast, the POLST is a medical order specifically for individuals who are seriously ill or frail, whose health status suggests they may need immediate, specific medical decisions.
The actionability of the documents is a major distinction. A POLST is a set of standing medical orders that must be immediately honored by EMS personnel. An Advance Directive, being a legal instruction, is not generally honored by first responders because it requires interpretation and is not a direct physician order. Furthermore, the POLST focuses on a narrow scope of immediately relevant treatments like resuscitation and the level of intervention. An Advance Directive covers a broader range of situations and primarily focuses on who will make decisions for the patient if they cannot speak for themselves.
Implementation and Revision
Once a POLST form is completed and signed, its practical implementation is focused on ensuring its accessibility during an emergency. The original form is typically kept in the patient’s medical record and a copy is often prominently displayed in the patient’s residence, such as on the refrigerator, so EMS can easily find it. The form travels with the individual across different healthcare settings, promoting continuity of care.
The POLST can be changed or revoked at any time by the patient or their surrogate decision-maker. If a patient’s health status or goals of care change, a new POLST form is completed to reflect the updated wishes, and the old form is marked as void. This process requires a new discussion and the signature of the authorizing healthcare professional, ensuring the document always aligns with the patient’s current condition and preferences. While the form is generally honored across state lines, patients should be aware of state variations regarding portability and the use of electronic registries.