POLST vs. Advance Directive: What's the Difference and Which Do You Need?
By CRYSTAL BAI •
The short answer: A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order signed by a doctor that gives immediate instructions to emergency responders and healthcare providers. An advance directive (living will or healthcare proxy) is a legal document expressing your general wishes for future care. You may need both — the POLST for immediate medical situations, the advance directive for longer-term planning.
What Is a POLST Form?
POLST stands for Physician Orders for Life-Sustaining Treatment (also called MOLST, MOST, or POLST depending on your state). It is a standardized medical order — signed by both a physician and patient — that translates end-of-life wishes into actionable medical instructions. A POLST travels with the patient across care settings (home, hospital, nursing facility, ambulance) and tells first responders and healthcare providers exactly what interventions are or are not authorized. It typically covers CPR, mechanical ventilation, artificial nutrition, and hospitalization preferences.
What Is an Advance Directive?
An advance directive is a legal document — not a medical order — in which a competent adult expresses their wishes for future medical care and names a healthcare proxy (also called healthcare power of attorney or agent) to make decisions if they become incapacitated. Advance directives include living wills (specific instructions) and durable power of attorney for healthcare (proxy designation). They are prospective documents that become active only when the person loses decision-making capacity.
Key Differences Between POLST and Advance Directive
POLST: Medical order. Requires physician signature. Takes effect immediately. Guides emergency responders. Must be updated as condition changes. Specific and actionable. Advance Directive: Legal document. Requires notarization or witnesses (varies by state). Takes effect only upon incapacity. Does not bind emergency responders unless implemented by a doctor. Broad and values-based. The critical insight: an advance directive expresses your wishes; a POLST puts those wishes into medical action.
Who Should Have a POLST?
A POLST is most appropriate for people with a serious illness, advanced age, or frailty — those for whom emergency intervention would be burdensome or contrary to their wishes. It is especially important for patients living at home with a DNR/DNI preference, because without a POLST, paramedics are legally required to attempt resuscitation. A death doula can help families understand when a POLST is appropriate and facilitate the conversation with the attending physician.
Who Should Have an Advance Directive?
Every adult should have an advance directive — not just those who are sick. Accidents and sudden illness can strike anyone. A basic advance directive names a healthcare proxy and states general preferences about life-sustaining treatment, resuscitation, and end-of-life care. Most states offer free advance directive forms, and organizations like Five Wishes and the Conversation Project provide guided templates.
Can You Have Both?
Yes — and you often should. The advance directive captures your broad values and designates your proxy. The POLST translates those values into specific medical orders for your current condition. A death doula facilitates these conversations, helps document your wishes, and ensures both documents are completed, signed, and accessible to your care team.
Frequently Asked Questions
Does a POLST override an advance directive?
In an emergency, a POLST takes precedence over an advance directive because it is a medical order. However, they should align — your advance directive should inform your POLST completion.
Do I need a lawyer to create an advance directive?
No — most states provide free advance directive forms that only require witnesses or notarization, not an attorney. A death doula can help you complete these forms.
Can a POLST be changed?
Yes — a POLST can be revoked or updated at any time while you are competent. It should be reviewed whenever your condition, wishes, or care setting changes.
What happens if I don't have a POLST and I don't want CPR?
Without a POLST, paramedics will typically attempt CPR regardless of your verbal statements or advance directive. A POLST is the only way to legally instruct first responders to withhold resuscitation in most states.
How does a death doula help with POLST and advance directives?
A death doula facilitates the conversation about your values and preferences, helps you complete both documents, coordinates with your physician for POLST signing, and ensures documents are distributed to all relevant care providers.
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