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Assuring that wishes are honored at
end of life
Very likely, this man’s friend
did not have a POLST. The POLST form (Physician Orders for Life-Sustaining
Treatment) is designed for individuals with serious or life-threatening
illness. It was developed to ensure that a patient’s wishes
for care would be honored by all medical personnel in the event
that the patient is unable to speak for him/herself. It can
be used to guide daily care decisions such as the use of CPR
or tube feeding. It also states that measures to ease pain are
always provided regardless of any other care decisions.
The POLST form originated from
the work of a multidisciplinary task force in Oregon in the
early 1990s. It has continued to evolve on the basis of research
studies and feedback from healthcare providers. The version
we use today clearly states direction for resuscitation, medical
interventions, antibiotics, and artificial feeding. (Return
to list)
Different from an advance directive
The POLST form is different
from an advance directive.
An advance directive states the patient’s wishes and
appoints a healthcare representative to make decisions if
the patient is unable to do so. This is important information
for family members to know. But an advance directive does
not have the kind of authority in the healthcare system that
a POLST does. The POLST is an actual order from a physician,
like a prescription. It gives specific directions to medical
personnel and is strictly followed. It can be filled out by
a nurse or social worker, but it must be signed by a physician
or nurse practitioner in order to be activated.
All patients should have both
an advance directive and a POLST. If a patient is no longer
able to speak for himself or herself but has an advance directive
and a healthcare representative, the physician who is preparing
the POLST form should consult the healthcare representative.
The advance directive and the healthcare representative will
provide information about the patient’s preferences that
will be helpful when completing the POLST. (Return
to list)
How do we make sure medical personnel
see the POLST?
The POLST is a bright pink,
two-sided form that measures 8.5 x 11 inches. The original
form should always be with the patient at his or her residence
or healthcare facility. If the patient lives at home, the
form should be kept in a prominent place such as posted on
the refrigerator in a red envelope for ready access by emergency
personnel. Caregivers and members of the family should know
the location of the form. If the person is in a healthcare
facility, it should be kept at the front of the chart. Now
there is even a version of the POLST that can be carried in
the patient’s wallet. (Return to list)
What if the patient changes his
or her mind?
A conversation with the patient
or the healthcare representative is a required part of the
POLST when it is initially filled out. To ensure that the
patient’s wishes are carried out, the POLST cannot be
changed in any way unless there is another conversation. The
names of those who participated in the conversation are documented
on the form. (Return to list)
Where do I get a POLST?
In Oregon, you need a healthcare
provider to complete the POLST form. Ask your physician,
nurse, practitioner, or healthcare facility to help you with
this. Our website article about planning
healthcare decisions includes a section called "Life-Supporting
Measures." You may find it helpful when you are thinking
about the questions your doctor will want to have answered
in order to complete the POLST. (Return
to list)
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