You may have heard about a new kind of health care directive in Wisconsin, called a Physician Orders for Life-Sustaining Treatment (POLST) form. Here, we discuss what a POLST form is and when you might 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. The POLST form may also provide other information about your wishes for end-of-life health care, as explained below.
In Wisconsin, the POLST form is currently available in nursing home, home health, and hospice settings in just a handful of counties, including LaCrosse, Monroe, Vernon, Richland, and parts of Trempealeau. In the future, the form may become available in other parts of the state.
A health care professional can help you create a POLST form if you enter a participating medical care facility or setting. To be legally valid, the POLST must be signed by a qualified health care provider. The rules on who may sign a POLST form in Wisconsin are in flux. A POLST form published by the La Crosse Area Advanced Directive Task Force restricts provider signatures to physicians and nurse practitioners, but other versions of the form are currently under consideration in the state. Until there is a state rule settling the matter, it's best to have your treating doctor sign the form. In addition, to ensure your wishes will be carried out, you (or your legally appointed health care representative) should also sign the POLST.
A POLST form is usually printed on brightly colored 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 living will and power of attorney for health care. Taken together, a Wisconsin living will and power of attorney for health care provide more information than a POLST form, including information about your health care agent, your wishes for organ donation after death, and other health care instructions.
You need to consider a POLST only if you're facing a life-threatening medical condition. If you're healthy, you need only a living will and a durable power of attorney for health care 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 benefit from a POLST in addition to traditional health care directives. 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 traditional health care directives.
For details about making health care directives in Wisconsin, see Wisconsin Living Wills and Powers of Attorney for Health Care: What You Need to Know.
To learn more about POLST forms, visit www.polst.org. To find out whether the POLST form is available in your region, talk to your doctor.
For general information about how to document your health care wishes, see the Living Wills & Medical Powers of Attorney section of Nolo.com.