You may have heard about a new kind of health care directive in California, called a Physician Orders for Life-Sustaining Treatment (POLST) form. Here, we discuss what a POLST form is and when you need one.
What Is a POLST Form?
A POLST form is a doctor’s order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, the form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. A POLST form may be used in addition to -- or instead of -- a DNR order. The POLST form may also provide other information about your wishes for end-of-life health care.
How to Make a POLST Form
A POLST form must be signed by a doctor, or a nurse practitioner or physician assistant acting under the supervision of the doctor. (Cal. Prob. Code § 4780.) A health care professional can help you create a POLST form if you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. If a member of the medical staff does not ask you whether you want to create a POLST form, you may ask for one.
In California, a POLST form is usually printed on bright pink paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.
How Does a POLST Form Differ From Other Health Care Directives?
A POLST form differs from a DNR order in one important way: A POLST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The POLST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared advance health care directive. An advance directive provides more information than a POLST form, including details about your health care agent, more complete health care wishes, and your preferences for organ donation.
Which Health Care Directives Do You Need?
You need to consider a POLST only if you're facing a life-threatening medical condition. If you're healthy, you need only an advance directive to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.
On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may need a POLST in addition to a traditional health care directive. That’s because a declaration and medical power of attorney may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as a POLST or DNR order. If you feel strongly that you don’t want emergency measures at the end of life -- or if you’re caring for someone who feels that way -- find out about making a POLST in addition to an advance health care directive.
For details about making an advance directive, see California Living Wills and Advance Health Care Directives: What You Need to Know.
For More Information
For more on California estate planning issues, see our section on California Estate Planning.