You may have heard of something called the POLST Form (“POLST”) and wondered if you need one. The POLST (Physicians Orders for Life-Sustaining Treatment) is a relatively unknown and certainly underutilized document which can assist with advance care planning for seriously ill individuals.
When planning for end-of-life medical care, most people think of an advance directive (also known as a living will) or the health care power of attorney (a document which appoint a health care proxy). A POLST is neither of these. It is a third useful tool. POLST is an actionable medical order (similar to a do not resuscitate order). It is the culmination of a shared decision-making process between a seriously ill individual and his or her health care provider. POLST is not appropriate for everyone. It is limited to those individuals whom their physicians think may die in the next year.
The POLST is completed as a result of informed, shared decision-making between the patient and health care provider. During this conversation, a patient discusses his or her values, beliefs and goals for care. At the same time, the health care provider presents the diagnosis, prognosis and treatment alternatives, including the benefits and burdens of life-sustaining treatment. The form enables a physician to order treatments that the patient would want and to direct that those treatments not desired or considered “extraordinary” not be provided. POLST requires that “ordinary” measures to improve a patient’s comfort and food or fluid by mouth, as tolerated, must be provided. POLST recognizes that allowing a natural death to occur is not the same as killing. It does not allow for active euthanasia or physician assisted suicide.
Only a state authorized health care professional who is legally allowed to sign medical orders may sign the POLST. The patient or the health care proxy may sign the POLST, but it is not required in all states.
As a medical order, the POLST is followed in times of crisis by EMS personnel in accordance with protocol, and by treating health care professionals. Advanced directives are not medical orders so EMS personnel cannot follow them; instead, they are generally reviewed once the patient has been transported to the health care facility.
What is important to take from all of this is that you may not need a POLST, but you may know someone who does. As an actionable medical order signed by a health care professional, the POLST allows a seriously ill individual to express his or her values and beliefs in a meaningful way that is recognized and followed during times of medical emergency, even before the person reaches a health care facility. As such, the Trust and Estate attorneys at Obermayer Rebmann Maxwell & Hippel LLP recommend that everyone have an advanced directed and health care power of attorney, and if appropriate, explore establishing a POLST to ensure your loved ones and medical providers understand and can implement your wishes.
Janene B. Reilly is an attorney in Obermayer’s Philadelphia office, focusing her practice in the areas of estate planning and estate and trust administration. She can be reached at 215-665-3062 or Janene.Reilly@obermayer.com