Physician orders for life-sustaining treatment, or POLST, is a form that expresses your preferences for end-of-life treatment, and medical professionals are usually obligated to follow it. With a POLST form you can state whether you want CPR, a feeding tube, and other types of care. POLSTs are created by a doctor to document a patient's wishes, and it is voluntary to make one — you can't be forced to.
POLSTs are commonly used by elderly patients who are severely ill, frail, and near death, differentiating them from advance directives, which even healthy individuals can benefit from creating as part of their estate plan, since they can help to plan broadly for future circumstances. Every state has some form of POLST, which may have a slightly different name, like MOLST (medical order for life-sustaining treatment), but they should cover the same ground.
POLST forms are a voluntary part of advance planning, and not everyone needs one
A POLST form doesn’t replace an advance directive, but it can work in conjunction with one
You can create an advance directive yourself, but you need a doctor to prepare a POLST since it’s a medical order
Health care workers are typically obligated to follow the patient's wishes as documented on their POLST form
How does a POLST form work?
POLST forms typically contain instructions about your preferences for life-sustaining medical treatment, and must be completed by a doctor. They are commonly divided into three parts.
The first section is about CPR, and whether or not the patient wants to be resuscitated if they are found without a pulse.
The second section usually outlines the scope of medical intervention and treatments a patient wishes to receive once they're breathing, including antibiotics and medications, IV fluids, dialysis, breathing support, and comfort (palliative) care.
The third section states when and if the patient should receive artificial nutrition and hydration, as through feeding tubes.
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When you come in contact with any medical personnel they are generally required to follow the guidelines set out in your POLST. However, in some states emergency medical services, like EMTs, are legally required to try and resuscitate you regardless of your POLST — unless you've filled out a separate out-of-hospital DNR (do not resuscitate) order.
Who needs POLST?
Not everyone needs a POLST form, which is best suited for seriously ill patients who are nearing the end of life. Frail elderly individuals, people with advanced illness, like heart disease, lung disease, or cancer, might consider getting a POLST. A portable medical order can provide continuity of care when you move between different medical facilities (like if you're transferred in and out of different hospitals, nursing homes, or rehab facilities) and require any health care professionals you encounter to stick to the course of treatment that you and your doctor discussed and laid out in the form.
If you don’t have a life-threatening illness, a POLST may not be right for your situation — but you can still outline your preferences for medical treatment through other means, like living wills. Having an advance directive in place can ease the burden for your family members if they find themselves in a difficult situation, like when you’re in a coma and they need to make decisions on your behalf.
How to get a POLST form
POLST forms are standardized and easy to complete. They are signed by patient and doctor, but before that can happen both parties need to have a discussion about the patient's medical condition and their preferences for treatment. The doctor can guide you through potential types of health care you may or may not want to receive and create the POLST order according to your wishes. In some states a physician assistant or nurse practitioner may be able to complete the POLST instead of a doctor. The chart below lists what the POLST form is called in your state and a link to the program or form if applicable.
POLSTs do not expire. You can revoke the POLST form by voiding it and creating a new one. You can also authorize someone you trust to sign the form on your behalf or change it, should you become incapacitated.
POLST form and program by state
POLST vs. advance directive
POLST forms and advance healthcare directives can both relay what kinds of medical treatments you want to receive, including whether or not you want life-sustaining treatment like CPR — but these two elements of advance planning differ in how they're completed and what they ultimately achieve.
Advance directives come in a few different types, and they are all legal documents that you can make on your own, unlike a POLST form. A living will outlines your general preferences for medical treatment, like whether or not you want to be resuscitated if your heart stops, and a healthcare proxy (also known as a medical or health care power of attorney) can let you authorize an agent to make decisions regarding your medical treatment on your behalf.
Related article: What is a durable power of attorney?
POLST forms address medical treatment, usually in regards to specific conditions or a critical illness, which is why only certain people need one. Everyone however can benefit from creating an advance directive as part of their estate plan.
How do you change it?
The process of changing and revoking a POLST and advance directives is different. You can draw up a new advance directive on your own, along with any other estate planning documents if your wishes have changed, but the contents of a POLST must be changed with a doctor just like when it was created. In general, POLSTs are periodically reviewed by a physician, and they may be updated frequently depending on your condition and whether it necessitates a different course of treatment.
Where do you store it?
POLST forms are generally kept somewhere visible, like on the refrigerator, and they are often printed on bright colored paper to help ease locating the form during an emergency. Some states may require that the form is filed with their POLST registry.
An advance directive, on the other hand, may be stored with other end-of-life or estate planning documents, like a will, with copies given to a close family member, trusted friend, or doctor to have on record. They may be harder to find during a medical emergency.
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