Critter Corner: What is a POLST Form and Does it Replace an Advance Directive?

Dear Hayek,

When reading about Advance Medical Directives, I saw something about a POLST form. What exactly is that, and if we have one, do we need an Advance Directive also?

Thanks!
Paul Stuh


Dear Paul,

A POLST (Physician Order for Life-Sustaining Treatment) form is a medical order for the specific medical treatments you want during a medical emergency. POLST forms are appropriate for individuals with a serious illness or advanced frailty near the end-of-life.

A POLST form does not replace an advance medical directive; rather, they work together. All adults should have an advance directive, not everyone needs a POLST in place. A POLST Is essentially a more modern version of a DNR (do not resuscitate) order, just as an advanced medical directive is a more modern version of the old-fashioned living will. Both a DNR, which can only be signed by a doctor, and a living will, which a patient signs,
are limited “one size fits all” documents and simply say “terminate life-support or do not start life-support.” The more modern advance medical directive and POLST‘s are much more complex documents that allow patients and doctors to specify exactly what types of life-support they would and would not want under certain situations, and thus are much more useful and flexible than the old-fashioned living wills and DNR’s.

The POLST is called different things in different states. In DC, it is referred to as a Medical Orders for Scope of Treatment (MOST); in Maryland it is called a Medical Order for Life–Sustaining Treatment (MOLST); and in Virginia it is called a Physician Order for Scope of Treatment (POST). Click here for more state specific details.

Should you have an Advance Directive and a POLST Form? What is the Difference?

An Advance Medical Directive is also called different things in different states (such as a health care power of attorney; a health care directive; or s health care proxy) but, regardless of the term, an Advance Medical Directive is a legal document you sign to provide guidance about what types of treatments you may want to receive in case of a future, unknown medical emergency. It also is where you say who can speak for you to make medical treatment decisions when you cannot speak for yourself.

A POLST form gives medical orders by a doctor (it must also be signed by you, or by your agent acting under your advance medical directive) and tells emergency personnel what treatments, if any, you want to have during a medical emergency. Again, someone seriously ill or frail and towards the end of life should consider having a MOST, MOLST, or POST form, either in addition to or instead of a DNR or Durable DNR.

If you have an Advance Medical Directive in place and the time comes when you can no longer speak for yourself, your health care team will review your advance directive and talk to your healthcare agent to follow your wishes.

Hope this is helpful!

Hayek

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