What is a POLST?
A POLST is a Physician Order for Life-Sustaining Treatment. In other states, it may be known as MOLST, MOST, or POST, but in Minnesota, we use “POLST.”
The POLST form has 3 major sections for which the patient, in consultation with their physician, selects their choices: Section A covers cardiopulmonary resuscitation, Section B covers the level of medical intervention the patient wants, and Section C covers artificial nutrition and hydration.
It is not the same as a DNR order – although it can include DNR instructions.
BUT, be careful – It’s not a substitute for a Health Care Directive.
It’s like a Health Care Directive (HCD) in that it includes directions for medical treatment, but it is considerably shorter, directions are easily and quickly communicated on a consistent and familiar form, and it is meant to function in a more immediate and current health care circumstance that is happening to you right now.
It’s unlike a HCD in that it includes your signature (or someone who is allowed to sign for you) and a physician’s signature (which is where the “order” comes into play). As a result of its efficiency, familiarity, and the weight of the doctor’s order, it is thought to be a helpful confirmation and assurance of your end-of-life treatment choices as you are currently experiencing a serious and terminal illness. The doctor can’t create a POLST without you wanting one, and you can’t make one without the doctor agreeing that you need one.
Loss of Mental Capacity? – still possible to create a POLST by signature of a surrogate decision-maker. The patient, through the power of a HCD (appointed agent) or a court-appointed Guardian, or a default surrogate decision-maker, authorized by Minnesota laws, may create the POLST with the physician.
Why or when would I need one?
One article I read on the subject (American Bar Association Journal of Real Estate, Trust and Estate Law, Vol. 49, No. 1, Spring of 2014) talks about using the “surprise” question as a measuring stick for needing a POLST. Question: Would the individual’s caregivers and physicians be surprised if the individual died within the next year? If the answer is “no,” then that individual and their physician should discuss whether a POLST is appropriate and what the appropriate contents of the order should be. If the answer is “yes,” then perhaps a POLST is not an appropriate choice.
A POLST is meant to be used as a supplement to your HCD and only under certain conditions. A HCD is meant to be an opportunity for you to express everything from broad feelings and fears to specific treatments and expectations. If one takes full advantage of the breadth of the HCD, it can cover all of the many possibilities for what is likely a currently unknown future circumstance.
A POLST, however, would be something to discuss with your doctor when you are currently suffering from a terminal or very serious progressive illness. It’s not the unknown future anymore – it’s happening to you right now. Given your diagnosis, you may wish to include a POLST to help with 911 calls or emergency room visits, for example.
EXAMPLE: Ginger and Fred, a couple of married 55-year olds, decide they each need a HCD, and they contact their attorney who helped them with their Wills and Powers of Attorney last year. Currently Fred and Ginger are in good health. And, although Fred has recently been diagnosed with Parkinson’s, he’s feeling good right now, and he and his wife are enjoying an early retirement. Fred is not experiencing any symptoms, and his physician said he may well be without symptoms for a number of years yet. Fred and Ginger know how they wish to communicate to their families and physicians when, in the future, they are at the end of their lives. A HCD will allow them to name an agent, express their wishes, and instruct family and physicians about how they wish to be treated. Their attorney helps them draft a HCD and they share it with their family members, their agents, and their physicians.
Fast forward 12 years. Fred is still doing well, but Ginger has developed pancreatic cancer and has been given a very serious prognosis – maybe only weeks to live. Ginger and Fred discuss her impending end-of-life decisions, and Ginger asks about a POLST. They discuss with her oncologist her prognosis, her options, and her goals under these very specific circumstances of a current terminal condition. They choose to execute a POLST, which orders emergency medical response teams and health care professionals to not resuscitate Ginger if her heart stops or if she stops breathing, and includes the level of intervention she wants and the artificial hydration and antibiotics she does not want. The doctor signs, Ginger signs, and they hang the POLST up on the refrigerator at home so emergency personnel can see it if they need to respond. They know to look for the form, they know what it will tell them to do or not do, and they know the patient and their doctor have discussed it and chosen to use it.
How do I get one?
Your physician could provide one for you. Or, you can get one yourself. Here’s the Minnesota Medical Association’s website which includes a download-able POLST form and more information and FAQ on POLST.
What if I already have a Health Care Directive (HCD)?
A HCD is an important staple of your life planning documents (or estate planning, if you prefer), as is a Will or a Trust, and a Power of Attorney. HCDs are most often written for future events (this is why they are often referred to as “advance directives”) that are not yet taking place or of immediate concern, and they function only if/when you are no longer able to make your own decisions. A POLST, on the other hand, is meant to give contextual directions (or an immediate order) for a current health issue, which could include a progressive illness or extreme frailty. The decision-makers, if the patient is not able to be included in the choices by reason of lack of capacity, are required to honor the wishes in a HCD and make choices based on those previously expressed wishes.
Everyone over the age of 18 should have a HCD, but only some people, who are currently suffering from a serious or terminal prognosis should consider a POLST.
Does Minnesota encourage the use of a POLST?
Yes. Minnesota has implemented a program like many other states that educates the medical profession and the public, and its goal is to improve end-of-life care. Those states that are encouraging its use consider the standardization and the consistency helpful in responding to individuals’ end-of-life choices.
This blog is written by Bridget-Michaele Reischl, Attorney DECORO LAW OFFICE, PLLC www.decorolaw.com