POLSTs vs Advance Directives for Health Care - Part 1

Friday, November 16, 2012

    POLSTs (Physician’s Orders for Life Sustaining Treatment) and Advance Directives for Health Care are often confused.

    In this series of articles, I will outline what each is designed to accomplish, how to get the best results using each kind of document properly, and how to distinguish between the two.

    A POLST is a Physician's Order for Life Sustaining Treatment.  It is completely different from an Advance Directive for Health Care.

    A POLST is an order from a physician.  Nurses and ambulance crews are generally required to act in accord with orders from a physician.  They are not generally allowed to determine the course of treatment themselves.  There are standing orders for both hospital nurses and ambulance crews.  These are often "take all steps to revive," absent some contrary order from a physician.  If you don't want the ambulance crew to break your ribs to try to start your heart, cut your trachea to insert a breathing tube, put you on some sort of a ventilator, administer painful shocks to try to re-start your heart, and all the rest of the things that they might otherwise do, you have to be able to give them an order from a physician.

    That is an over simplification.  For example, if you are conscious and capable of making and communicating a health care decision yourself, you can obviously tell the ambulance crew or the EMTs not to do this to you, but if you need these services, you probably won't be conscious and capable of making and communicating such a decision.

    You put a POLST on your fridge (open - it is bright pink; or closed, in a red or pink envelope).  Ambulance crews are trained to look for this.

    There are also mini-POLSTs you might carry in a pouch around your neck, and there is an on line POLST registry.

    POLSTs, since they are physician orders, must be signed by a physician (or a nurse practitioner in some cases).  They are NOT something you pick up yourself and fill out and sign yourself.

    Ambulance crews and EMTs can follow POLSTs, since they are physician's orders.  An Advance Directive for Health Care is not a physician's order, and, as such, the ambulance crews and EMTs are generally unable to depart from their standard orders to revive at all costs if there is only an Advance Directive for Health Care, instead of a POLST.

    Similarly, a POLST does not give decision making power to a third person.  If, for example, you want your spouse or child to be able to make health care decisions for you once you are in the hospital, you should use an Advance Directive for Health Care.  A POLST will not give your spouse or child any additional right to make such decisions.

    In the next article in this series, I will discuss Advance Directives for Health Care, their uses, and some tricks and traps relating to Advance Directives for Health Care.