New York Estate Planning & Elder Law Blog
Is an advance directive enough to ensure that your wishes are followed when you cannot express them because of disease or illness that affects your ability to make decisions for yourself? Physician Orders for Life-Sustaining Treatment (POLST Orders) for short, are often confused with advance directives. These medical care planning tools are very different from each other.
What is an advance directive?
An advance directive consists of a living will and a health care power of attorney. Every adult, regardless of age, should have one and update them from time to time, especially following a diagnosis of a serious medical condition.
What is a POLST Order?
A POLST Order, or Portable Medical Order Form, is a medical care planning tool that is used near the end of the life of a seriously ill individual and is specific to the person’s current medical condition. POLST Orders are a patient’s instructions for medical care and treatment towards the end of a terminal illness. The patient is given full autonomy to decide painful an aggressive treatment or comfort care during the last stages of a terminal illness. In addition to being a written record of a your wishes for medical care and treatment, it also provides specific guidance to your medical providers .
Common POLST Order Forms
The major distinguisher between an advance directive and a POLST Order is portability. POLST Orders are designed to travel with the patient as part of his or her medical records and across health care settings. That means that these POLST Orders must be used by primary care doctors, hospitals, and nursing homes. Among the medical treatments you may elect to determine in advance of incapacitation are:
- cardiopulmonary resuscitation (CPR)
- antibiotics
- artificially administered nutrition and fluids
- blood transfusions
- dialysis
- future hospitalization
- comfort measures only
In New York, POLST Orders must be signed by the health care provider and individual. If the individual is unable to sign the POLST Order, two witnesses must sign the documents and attest that you consent. Click here to access signature requirements by state.
Should You Have POLST Orders?
Individuals with serious illnesses who cannot articulate their wishes should develop POLST Orders at the outset of their illness when they are still able to make decisions about their medical care and treatment. The following scenarios are likely to lead to a discussion with your medical provider about the establishment of POLST Orders:
- Individuals with serious illnesses that have been given 1 to 2 years to live;
- Individuals that have an increased risk of experiencing medical emergencies; or
- Individuals that have had multiple unplanned hospital admissions in the last 12 months.
Each state has its own requirements and may call the Portable Medical Order Form something other than POLST. In New York, the Portable Medical Order Form is called POLST. Other states call it POST ( physician orders for scope of treatment), MOLST (medical orders for life sustaining treatment) or MOST (medical orders for scope of treatment ).