New POLST form (Physician Orders for Life Sustaining Treatment)

A new type of health care decision making document was enacted into California law on January 1, 2009.  It’s called the Physician Orders for Life Sustaining Treatment (POLST).  Its purpose is to allow you and your doctor the opportunity to discuss your end-of-life decisions, put those choices in writing and make them enforceable through a physician’s order.

This form does not replace any other type of advance health care directive.  However, it gives elderly and terminally ill patients the opportunity to discuss with their doctor end-of-life decisions and to make those decisions become actual physician orders that all medical personnel must carry out.  This document differs materially from the average “Living Will”, precisely because the POLST form is an order from your doctor. The legislature has also enacted immunity statutes that protect all health care providers who, in good faith, rely on the doctor’s reasonable orders that are contained in the POLST form. This protects medical personnel from criminal prosecution, civil liability, and all other disciplinary actions for unprofessional conduct.

The form is very simple to understand and complete.  There are four (4) sections:

Section A.  Cardiopulmonary Resuscitation.  This section becomes applicable when a person has no pulse and is not breathing.  You can simply check one of two boxes, stating that you do or do not want medical staff to attempt resuscitation.  If you choose not to be resuscitated, then you are requesting that medical personnel allow natural death.

Section B.  Medical Interventions.  This section becomes applicable when a person has a pulse and/or is breathing.  There are three boxes that can be checked (a fourth box indicates whether you want to be transferred to a hospital for medical intervention):

(1)  Comfort Measures Only. By checking this box, you are instructing medical staff to provide medication, positioning, wound care and other measures to relieve pain and suffering.  Essentially, you are still asking to be allowed a natural death, but to be maintained as comfortably as possible.

(2)  Limited Additional Interventions.  This includes the comfort measures (above) and some additional care in the form of medical treatment, antibiotics, and IV fluids as indicated.  You are also requesting that you not be intubated, but non-invasive airway pressure is to be allowed.  Lastly, you are asking that intensive care generally is to be avoided.

(3)  Full Treatment.  Just like it sounds.  This choice includes the two above-mentioned, and requests additional treatment in the form of intubation, advanced airway interventions, mechanical ventilation, and defibrillation/cardioversion as indicated.  If required, you are also requesting transfer to a hospital including intensive care.  There is also a space to indicate additional orders.

Section C.  Artificially Administered Nutrition.  There are three (3) boxes that can be checked.  You indicate whether: (1) you want no artificial nutrition by tube, (2) you want a defined trial period of artificial nutrition by tube, or (3) you want long-term artificial nutrition by tube.  Of course, if you are capable of eating, then the medical personnel are to offer food by mouth.

Section D.  Signatures and Summary of Medical Condition.  Your physician will check off the box indicating that s/he discussed the POLST form with you (the patient), your health care decision-maker (this could be your named agent under an Advance Health Care Directive), your Court-appointed conservator, or other person.

There are spaces for signatures of both you and your doctor, along with contact information.

Of course, the POLST form can be modified or revoked at any time (so long as you have mental capacity).  Revocation can be verbal or written.

Application to HIPAA:  The Health Insurance Portability and Accountability Act generally restricts the sharing of private medical information without the patient’s informed consent.  HIPAA permits disclosure of the POLST form to other health care professionals.

The POLST form should be carried with you and a copy provided to all of your health care providers.

This form will help to ensure that you, or your elderly loved ones, have carefully determined what end-of-life decisions are desired and have received a physician’s order that they be carried out.