Physician Orders for Life-Sustaining Treatment (POLST)

POLST stands for “Physician Orders for Life-Sustaining Treatment.” Next to an advance health care directive (AHCD), a POLST is one of the most important documents you can have.

The POLST was developed in response to concerns that physicians were not honoring patients’ AHCDs. An AHCD expresses the patient’s wishes for end-of-life care; the POLST is a doctor’s order concerning end-of-life care.

The POLST is typically printed on ultra pink paper, although any color paper will do. The POLST program was first developed in Oregon, and California is one of a handful of other states that have adopted the paradigm. In California, the Coalition for Compassionate Care has taken the lead on educating the public; copies of the POLST are available on its website.

Studies have consistently shown that patients with POLST forms are more likely to have their wishes concerning end-of-life care honored than patients using traditional methods of conveying those wishes (e.g., AHCDs).

Patients and clients are becoming increasingly aware that traditional healthcare at the end of life is often invasive, expensive, and can result in unnecessary pain and suffering. Sometimes even a patient’s express wishes, written on paper aren’t enough. Sometimes the only way to save a client from the perils of western medicine is to find a doctor willing to issue the right prescription.


The most important document you will never write

An advance health care directive (AHCD) is a legal document designed to tell your doctors and your loved ones exactly how you want your health to be managed at the end of your life. In California, the Office of the Attorney General has put together a very helpful website that explains what an AHCD is, and even provides sample forms you can fill out and distribute to your health care providers and family members, no lawyer required.

Although it is relatively easy to complete an AHCD, a vast majority of people fail to do so. The great mystery is why. Certainly, many people find it uncomfortable to think about end-of-life issues. People who propose the government educate people about AHCDs are accused of wanting to create “death panels.” Also, we commonly segregate the elderly, so that choices concerning death and dying remain on the periphery. As a result, the importance of clearly spelling out end-of-life decisions fades into the hum and buzz of everyday life. Sometimes, it’s just hard to find the time to get your sh*! together.

The importance of completing an AHCD is particularly acute given the standard approach to end-of-life care in our culture. Absent an AHCD, an older adult is likely to be subjected to heroic measures when the adult might consider comfort care more appropriate, instead.

Certainly, the AHCD has its critics, and the form does not always communicate effectively the wishes of the patient at issue. However, the best way to make sure your end-of-life health care wishes are followed is to communicate what you want to those you love. A written document, such as an AHCD, is the best way to make those wishes clear.