What Is a Portable Order for Life-Sustaining Treatment (POLST)?
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A portable order for life-sustaining treatment (POLST), or medical order for life-sustaining treatment (MOLST) in some states, gives instructions for your care in a life-threatening medical situation. It’s often a bright pink form kept on the refrigerator so emergency medical personnel can see it. POLSTs aren’t advance directives.
POLSTs are free and fairly simple to complete. Having one can make a difference in your care, especially if you have preferences for life-sustaining treatments. For example, if you don’t want to be put on a ventilator or use a feeding tube in the hospital — or be taken to the hospital at all — a POLST form makes that clear.
For those with an advanced condition, receiving long-term care or otherwise approaching end-of-life treatment, this form can simplify treatment in an emergency situation. Here’s what to know about POLSTs and MOLSTs, and how to know if they’re right for you.
How does a POLST work?
POLST forms are intended to help health care providers honor your wishes for end-of-life care. Feelings about medical treatments and quality of life vary from one patient to another; for example, some might prioritize comfort over a life-sustaining measure such as a ventilator or feeding tube.
A POLST or MOLST is a brightly colored form — usually pink, but sometimes green or purple — and should be kept on the refrigerator for easy access in an emergency. “If emergency medical services (EMS) come to your home, they are trained to look at the refrigerator first for this form,” says Joan Smith, director of social work services at Tufts Medical Center.
Who should consider a POLST?
Anyone can fill out a POLST, but they’re strongly recommended for specific groups of people. If you or a loved one fall into one of these categories, you may want to consider a POLST:
Live in a nursing home or receive long-term care. “Many assisted living facilities will encourage you to complete [a POLST],” says Smith.
Have advanced chronic conditions including cancer, lung or heart disease, neurodegenerative disease, or are otherwise seriously ill or frail.
Have strong preferences against intubation or CPR, or want to avoid any life-sustaining treatment.
If none of the above describes you, an advance directive might be a better way to outline your future medical preferences.
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How to get a POLST
To get a POLST, request one at your next doctor appointment. You can complete a POLST form with a physician, nurse practitioner or physician assistant.
Filling out a POLST will require a conversation with your health care provider and will take into account your health status and treatment preferences. You’ll discuss each part of the form, which includes a range of medical scenarios, including resuscitation, ventilation and assisted nutrition.
If you have a POLST, you should also consider naming someone you trust as a health care proxy who can make decisions for you if you become incapacitated. Your proxy can use the instructions on your POLST as a guide for your medical preferences and can revise parts of your form if your health status changes.
POLST vs. advance directive
A POLST form is not the same as an advance directive, which is a legal document that specifies your future medical preferences if you become unable to communicate them. Advance directives include health care proxy forms, living wills and combined documents.
These are the key differences between POLSTs and advance directives:
Intended for elderly and chronically ill adults.
For everyone age 18 and older; typically a part of estate planning.
For immediate and emergency care.
For future and ongoing care.
Completed with a health care professional.
Completed by self or with an attorney.
Can be filled out by a proxy or agent.
Must be filled out in advance, by the patient.
Your advance directive documents may contain some of the same information in your POLST, including directions for comfort care. Make sure the instructions in both forms match to avoid confusion in a medical emergency.
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Is a POLST the same in every state?
POLST programs exist at some level in all 50 U.S. states and the District of Columbia, though the name and form differ among states. In some states, POLSTs are named for the state, such as the Louisiana physician orders for scope of treatment (LaPOLST). In others, such as New York and Massachusetts, they’re called medical orders for life-sustaining treatment (MOLST).
The weight a POLST carries can also vary. In New York, for example, a MOLST is the only legally authorized form to document DNR and DNI (do not resuscitate and do not intubate) orders outside of the hospital.
No matter what state you live in, a POLST helps your loved ones and health care professionals clearly understand your preferences for emergency treatment.