Physician Order for Life Sustaining Treatment (POLST)

A POLST form is a legally sufficient medical order that health care providers and health care facilities may use in accordance with their policies and procedures regarding end of life care. A POLST order remains effective unless the order is revoked by the attending physician upon the consent of the patient or the patient’s authorized person. An attending physician who has issued such an order and who transfers care of the patient to another physician must inform the receiving physician and the health care facility, if applicable, of the order. Review of the POLST form is recommended at care transitions, and such review should be specified on the form.

POLST forms for DNR and for other interventions signed by the patient and attending physician may be implemented without restriction. If the POLST form is signed by anyone other than the patient, then DNR provisions may only be implemented if the patient is a candidate for non-resuscitation, and other provisions withdrawing treatment may only be implemented if the patient has a terminal illness or is in a state of permanent unconsciousness.

The key feature of POLST forms is that they are portable. They may travel with the patient across care settings and are valid in any health care facility in which the patient who is the subject of such form is being treated; health care facilities may impose additional requirements regarding a patient’s end of life care decisions, so long as notice is given to the patient as required by the federal Patient Self-Determination Act and similar laws. A health care facility and a health care provider, in its discretion, may rely upon a POLST form as legally valid consent by the patient to the terms therein.

In the event there are any directions in a patient’s previously executed living will, advance directive for health care, durable power of attorney for health care, do not resuscitate order, or other legally authorized instrument that conflict with the directions in a POLST form, the most recent instrument will take precedence to the extent of the conflict.

See also National POLST

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