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Do you need a POLST, Physician Order for Life-Sustaining Treatment?

Written by Diane Archer

A POLST or Physician Order for Life-Sustaining Treatment is a type of advance directive written by a physician, which complements a person’s advance directive. All adults should have an advance directive documenting their end of life wishes. Adults in the last stages of life also would benefit from a POLST.

An advance directive includes a living will–a document that details the kinds of care people would like at the end of life–and a health care proxy–a document reflecting people’s wishes regarding who should speak for them if they cannot speak for themselves.

A POLST puts in writing a doctor’s medical orders to ensure that patients get the treatments they want and do not get the treatments they do not want in a medical crisis, when they cannot speak for themselves.

What is the difference between an advance directive and a POLST? All adults should have an advance directive documenting their end-of-live wishes. Adults who are relatively healthy do not need a POLST. Adults who are extremely frail or ill, with less than one year to live, should consider having a POLST. The POLST is written by physicians after speaking with their patients (or their health care proxies) about their diagnosis, prognosis, treatment options and goals of care. The POLST captures the kinds of medical care individuals would want in a medical emergency. A POLST is a medical order that can direct an emergency medical team.

What kinds of information would be included in a POLST? A POLST reflects an individual’s treatment wishes at the end of life. If individuals want all treatments possible to try to keep them alive, the POLST would document that they should get CPR and Full Treatment. Or, it might say that a patient only wants comfort measures and limited treatment. Patients always get interventions that offer them comfort, including food and fluid by mouth as tolerated. But, they may opt not to have food artificially administered.

A POLST might indicate that patients do not want to be resuscitated if they do not have a pulse, are not breathing and are non-responsive. But, rarely is that the case. So, a POLST might also indicate whether the patient wants to be moved from home to the hospital in an emergency or would prefer to remain at home.

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