Should a POLST Be Part of Your Care Plan?

The American Hospital Association estimates that half of Americans suffer from chronic conditions like heart disease, diabetes, and cancer. Following a diagnosis, many experience concerns about the kind of care they will receive. They may worry about how invasive it will be, and how it will affect their quality of life. Fortunately, you can proactively decide what treatments would – or would not – suit your preferences.

Posted on October 16, 2023

If you are one of the half of Americans with a condition that puts your health at risk, consider working with your health care provider to create a Physician Orders for Life-Sustaining Treatment (POLST).

By creating a POLST, those with long-lasting or terminal conditions can ensure they receive their desired treatment should their health decline. Creating a POLST could help you plan your treatment for an adverse health event or the end of your life.

What Is a POLST?

A POLST is a binding medical order detailing the types of treatment you wish to receive (or refuse). It is appropriate for those with severe medical conditions who are at risk for a life-threatening clinical event. For example, someone with heart disease may have a POLST in place in case of a stroke.

The purpose of a POLST is to convey clear, concise orders for health care providers who may care for you in the future across various medical settings, whether in a hospital, long-term care facility, or emergency transit. These instructions reflect your wishes and your doctor’s recommendations.

A doctor, nurse, or physician assistant can create the order with you. Both you and your provider must sign the POLST form.

While all 50 states allow for this type of order, it can have different names, such as Medical Orders for Life Sustaining Treatment (MOLST), in some states.

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      A POLST can be a valuable component of a long-term care plan. It should complement, but not replace, such documents as an advance directive or do-not-resuscitate order.

      Advance Directives: Health Care POAs and Living Wills

      Advance directives outline your instructions regarding what types of lifesaving treatment you would be willing to receive. These documents can prove useful in situations where you are no longer able to communicate.

      In a health care power of attorney (POA), an individual appoints a surrogate decision-maker, or agent. Your health care agent can make medical decisions for you, including what type of care you receive.

      A health care POA can help those anticipating medical events that could compromise their decision-making ability. The surrogate decision-maker is often a spouse, family member, or trusted friend. The expectation is that they will act in the patient’s best interests and make decisions according to their wishes.

      A living will is another type of advance directive where you can detail whether you’d approve invasive treatment to prolong your life, or only treatment to keep you comfortable as you pass naturally.

      Unlike a POLST, these other types of documents don’t require the signature of a health care professional. You need not discuss your wishes with your doctor to execute a health care POA or living will. It is a good idea to give copies of your health care POA documents to your provider, so that they are on file should your health decline and you need to use them.

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        Do-Not-Resuscitate Orders

        Like a POLST, a do-not-resuscitate order (DNR) is a binding medical order. Written by a doctor, the DNR prevents doctors and nurses from doing cardiopulmonary resuscitation (CPR) if your breathing or heart stops.

        While a POLST can cover a wider range of topics related to end-of-life treatment, a DNR is specific to CPR.

        Benefits and Drawbacks of a POLST

        Standard POLST forms are typically simple, limited to one page, and contain boxes for you to check indicating your wishes.

        Although the POLST allows you to make enforceable decisions before a negative health event occurs, some criticize the form's simplicity. Critics claim that the checkbox format prevents patients from explaining their reasoning or detailing the care they would like to receive.

        Consult an Attorney

        If you are considering creating a POLST, consider consulting with an estate planning attorney. They can help you create a plan that may incorporate a POLST and other directives that could be crucial to your care. By understanding how a POLST fits into a larger estate plan, you can prepare for the future effectively.

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