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.
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.
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.
To be legal, a POLST form must be signed by:
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.
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.
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 an advance directive 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 form. 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.
To learn more, and to view an example of the California POLST form, visit POLST California. (From that website, you may download the form in English or about a dozen other languages.) To prepare a POLST form for yourself or a loved one, talk to your doctor.
For more on California estate planning issues, see our section on California Estate Planning.