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POLST: Physician Orders for Life-Sustaining Treatment
By Dr. Susan Tolle
Does Your Parent or Loved One Have a Plan in Place?
Advanced care planning involves filling out different types of legal forms that concern your parent’s preferences concerning end of life treatments. These documents are advance care directives, such as a living will, and a power of attorney for health care. They are usually filed away and referred to when patients have been admitted to the hospital and are unable to speak for themselves.
A Patient’s Wishes May Fly Out the Window of the Ambulance
The problem with these documents is that they are considered value statements – not medical orders. Most people don’t realize that EMTs and other first responders cannot follow value statements. It is their job to do whatever it takes to save that person’s life. There are no brakes on medicine. Everything is matched by protocol: If the person is not breathing, intubate. If the heart is not beating, use electric shock. If blood pressure is low, give IV fluids. Even if someone is in the late stages of a life-threatening illness, and has decided to forego certain life-sustaining treatments, that person could end up in the ICU on a breathing machine.
POLST: It’s What the Doctor Ordered…and the Patient Wanted
But there is another type of form that more and more states are adopting. It’s most commonly referred to as POLST (Physician orders for life-sustaining treatment). This is a single page order sheet in a bright color and signed by a doctor. The POLST is usually placed in a prominent place, and it helps turn a person’s wishes about life-sustaining health care into action with medical orders that stand up in emergency situations – even outside of the hospital.
The POLST program is respected by everyone in each care setting – including the ambulance, the hospital, the nursing home. Everyone understands and abides by these wishes that have been turned into medical orders. This is something unique in healthcare, where many of our health systems don’t talk to each other or share information.
The POLST program lets your parent or loved one make decisions every step along the way. Early in the illness, when someone is feeling fairly healthy, that person may want everything available. But later when the illness is advanced, dialysis or a breathing machine may not be wanted. The POLST isn’t only about refusal; it spells out both exactly what is not wanted and what is wanted.
Keep POLST Close to the Patient
The POLST should stay with the individual. In the final weeks of life, it’s not uncommon to stick it on the refrigerator where first responders can see it. There are also wallet-sized POLST cards. POLST is not for everyone.
While it’s smart for anyone to have an advanced directive, healthy individuals do not need a POLST form. It is only for people with serious advanced illness.
Dr. Susan Tolle is the Director and Cornelia Hayes Stevens Chair for the Center for Ethics in Health Care at Oregon Health & Science University. She received her medical degree from the OHSU School of Medicine and her training in Internal Medicine at the University of California, San Diego. Dr. Tolle completed her fellowship in Clinical Medical Ethics at the University of Chicago.
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