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The other day, I asked several people if they knew the definition of POLST. They offered a variety of interesting answers. One person said it sounded like something people ate in the old country. Another guessed that it’s a creature in a scary movie. (Rather like a miniature poltergeist, perhaps?) Yet another thought it might be a piece of farm equipment.
A few people knew the real meaning of a POLST: Physician’s Orders for Life-Sustaining Treatment. (In some states, they may use a different acronym.) Even though POLST has been around since 1991, I find most people aren’t familiar with this concept. That’s why today I’ll try to answer some of the most common questions about POLST.
Before we begin, I want to point out that laws regarding POLST vary from state to state. You can find out more about the rules in your state by checking the official POLST website.
What is POLST?
I like the definition of POLST as described on Wikipedia: “an approach to improving end of life care in the United States, encouraging providers to speak with patients and create specific orders to be honored by health care workers during a medical crisis.”
Isn’t POLST the same thing as an advanced directive?
No, while both serve an important purpose, they are not the same. Many people use both forms.
1. An advanced directive is often created by a healthy adult. A POLST form is only appropriate for someone who is seriously ill with a progressive disease or when they are at the end of life.
2. A person can choose to fill out an advanced directive without input from anyone else. The POLST requires a discussion with a medical professional.
3. An advanced directive goes into effect in the event of an unanticipated medical emergency when an individual cannot communicate their wishes. The POLST goes into effect as soon as the medical provider and the patient sign it.
4. Advanced directives are not medical orders. Therefore, they won’t necessarily be followed by medical personnel. Rather, they offer guidance as to a person’s treatment wishes. A POLST, on the other hand, is a signed medical order that medical personnel must follow.
5. An advanced directive designates a surrogate decision-maker if a person cannot communicate their wishes. The POLST does not include this feature.
How do I complete a POLST?
In some states, you can download a POLST form from a designated website. In other states, you must get it from a health care provider.
Regardless of where you receive the form, you must fill it out with a medical professional. In some states, this means an MD, while in other states it might be a nurse practitioner or a physician’s assistant.
The medical professional needs to review several issues to help you make your healthcare decisions. These include:
- Your diagnosis
- The expected course of your illness
- Treatment options
- Your care goals
What topics does a POLST form address?
There are four principal topics on a POLST form:
A. Whether you wish to receive CPR in the event of a cardiac arrest.
B. Your wishes regarding a variety of medical interventions such as hospitalization, breathing machines, and IV fluids.
C. The circumstances under which you wish to receive antibiotics.
D. Whether you want to receive artificial nutrition (tube feedings).
Does the POLST advocate assisted suicide?
Absolutely not. While some people have expressed this concern, nothing in POLST supports assisted suicide or euthanasia. POLST focuses on the medical care a person wants to receive during their last days, not on hastening death.
Who has access to my POLST?
A nice feature of the POLST is the fact that it travels with you. At home, many people keep the POLST form on their refrigerator. This allows for easy access if emergency services come to your house.
The form also becomes a part of your medical record at the clinic, hospital, nursing home, or any other medical facility where you receive care. Certain states also have a registry where emergency personnel can quickly access your POLST form.
Will a medical facility require me to have a POLST?
No, a POLST is completely voluntary. However, many hospitals and other health care facilities offer information about POLST as a service to their patients.
Can a POLST be changed or canceled?
Yes, you can change your wishes at any time by consulting a designated health care provider. A patient can also choose to void the form. It’s important to review the POLST periodically, especially if there is an improvement in a person’s condition.
Do you have other questions about POLST? Please let me know in the comment section.
For more information about end-of-life care in the nursing home, check out this previous post.
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