What Is a POLST Form and How Does It Work?
By CRYSTAL BAI •
The short answer: A POLST (Physician Orders for Life-Sustaining Treatment) form is a medical order — signed by a physician, NP, or PA — that specifies your CPR, hospitalization, and artificial nutrition preferences for medical emergencies. Unlike an advance directive, it is immediately actionable by first responders and healthcare providers.
What Is a POLST Form?
POLST stands for Physician Orders for Life-Sustaining Treatment (called MOLST, MOST, or IPOST in some states). It is a portable medical order — a document signed by a licensed healthcare provider — that translates your end-of-life wishes into specific medical instructions that can be acted on immediately in an emergency.
POLST vs. Advance Directive: Key Differences
Both documents help ensure your healthcare wishes are honored, but they serve different purposes:
| Feature | POLST | Advance Directive (Living Will) |
|---|---|---|
| What it is | A medical order | A legal document expressing wishes |
| Who signs it | Patient AND physician/NP/PA | Patient (and witnesses/notary) |
| When it's used | During a medical emergency — immediately actionable | When you cannot speak for yourself (may require interpretation) |
| Who it applies to | Seriously ill patients, frail elderly, terminal diagnosis | Any adult planning ahead |
| First responders | Can follow directly | Cannot follow directly — needs physician interpretation |
What a POLST Form Covers
A POLST form typically addresses three main areas:
Section A — CPR: Whether to attempt cardiopulmonary resuscitation if your heart stops. Options: Attempt CPR / Do Not Attempt Resuscitation (DNAR/DNR).
Section B — Medical Interventions: The level of medical intervention desired if your heart is still beating but you are unconscious or seriously ill. Options range from: Full treatment (including ICU, intubation, all interventions) / Selective treatment (hospitalization but no ICU or intubation) / Comfort-focused care only (symptom management, home/hospice setting preferred).
Section C — Artificially Administered Nutrition: Whether to use feeding tubes if you cannot eat. Options: Provide feeding tube / Trial period and then reassess / No feeding tube.
Who Should Have a POLST Form
POLST is designed for people who are seriously ill or frail — not for healthy young adults. Appropriate candidates include:
- People with a terminal diagnosis (cancer, ALS, advanced heart failure, etc.)
- Frail elderly individuals in nursing homes or assisted living
- Anyone on hospice care
- People with advanced dementia
- Anyone whose physician would say "I would not be surprised if this patient died in the next year"
How to Complete a POLST
A POLST must be completed with your physician, nurse practitioner, or physician assistant — ideally after a thorough goals-of-care conversation. The form must be signed by the healthcare provider to be a valid medical order. Once completed, keep the original somewhere visible and accessible (on the refrigerator, by the bed) so first responders can find it. Copies should go in your medical record, with your hospice agency, and with family members.
What Happens if You Don't Have a POLST
Without a POLST, emergency responders are required to attempt full resuscitation — even if that goes against your wishes. This is why the POLST is critical for anyone who does not want aggressive intervention. An advance directive alone is not enough for emergencies.
Updating or Revoking a POLST
A POLST can be updated or revoked at any time if your wishes change. This should be done with your healthcare provider. Tear up or mark "VOID" on old forms and create a new one that reflects your current wishes.
Frequently Asked Questions
What does POLST stand for?
POLST stands for Physician Orders for Life-Sustaining Treatment. In some states it is called MOLST (Medical Orders for Life-Sustaining Treatment), MOST, or IPOST. All refer to the same type of portable medical order documenting end-of-life treatment preferences.
Is a POLST the same as a DNR?
No. A DNR (Do Not Resuscitate) order only addresses CPR. A POLST is broader — it covers CPR, the level of medical intervention desired (including hospitalization and ICU), and artificial nutrition preferences. A POLST includes a DNR choice as one option.
Who needs a POLST form?
POLST is designed for people who are seriously ill, frail, or in the last stages of life — not healthy adults. If you have a terminal illness, are enrolled in hospice, have advanced dementia, or are a frail older adult in a care facility, a POLST is essential for ensuring your wishes are followed in an emergency.
Can family members override a POLST?
No. A properly completed and signed POLST is a valid medical order. Healthcare providers and first responders are legally obligated to follow it. Family members cannot legally override a valid POLST, though conversations about wishes should ideally happen before crisis.
What is the difference between a POLST and an advance directive?
An advance directive is a legal document expressing your wishes for the future — it guides decision-making but requires interpretation and cannot be directly followed by first responders. A POLST is a medical order that can be acted on immediately — first responders and emergency personnel can follow it directly without physician interpretation.
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