POLST & Advance Directives

No. Both advance directives and POLST Forms are advance care plans.  They support each other but do different things.

All adults should have an advance directive (also called a living will or health care power of attorney, depending on what state you live in) because it allows you to appoint a surrogate to speak for you when you cannot speak for yourself. An advance directive does not give medical orders but it provides an idea of what treatments you may wish to have whenever you may have a medical emergency but can't communicate.  When you can't speak for yourself, your health care team will review your advance directive and talk to your surrogate to develop a treatment plan.

A POLST Form gives medical orders and tells emergency personnel what treatments you want to have during a medical emergency.  Only someone seriously ill or frail and towards the end of life should consider a POLST Form. 

A POLST Form is a medical order that tells emergency health care professionals what to do in case of a medical crisis where the patient cannot speak for him/herself.  An advance directive is a legal document that tells who the patient wants making medical treatment decisions for him/her when he/she cannot speak and, generally, what treatments the patient does or does not want.

No. A POLST Paradigm Form gives medical orders to emergency health care professionals to follow. Since the POLST Form is completed only when someone is seriously ill or frail, their diagnosis and prognosis is known and so more specific treatment decisions can be chosen and documented on a POLST Form.

An advance directive is a legal document, not a medical order, and does not provide treatment orders. Instead, it lets health care professionals know generally what types of treatment the patient may or may not want during some unknown medical crisis.

Since a POLST Form is a medical order, EMS/EMTs can follow the orders during an emergency. If you only have an advance directive, EMS/EMTs must do everything possible to attempt to save your life. Once you are stable, then health care professionals will review your advance directive with the person you named as your surrogate, and decide on a treatment plan based on the guidance you provided in your advance directive.

All adults should have an advance directive. The advance directive lets health care professionals know generally what types of treatment the patient may or may not want during some unknown medical crisis. It also says who your surrogate is: the person authorized to speak and make medical treatment decisions for you when you are unable to speak for yourself. Since most adults are healthy and don't know what type of medical emergency they will have, this document provides general information that can be used in making a treatment plan with whomever you decide is your surrogate.

Only people who are seriously ill or frail and towards the end of life should have a POLST Form. This form provides specific medical orders letting everyone know what they want in case of a medical emergency. If there are any questions and the person cannot speak for him/herself, the health care professional will look at the patient's advance directive to figure out whom to talk to.

No. Only an advance directive can be used to identify a surrogate. A surrogate is someone you choose to speak for you when you cannot speak for yourself during a medical crisis. When you pick that person, you are saying they have the authority to make medical treatment decisions for you.

Choosing a surrogate is a legal process, so you will use the legal document, an advance directive.

The POLST Form is a medical order.  Most state POLST Forms ask for surrogate contact information, but this does not designate that person as your surrogate.

If you are not seriously ill, frail, or towards the end-of-life you should only have an advance directive.

If you are seriously ill or frail and towards the end-of-life, you should have both because they provide different pieces of information. The POLST Paradigm Form tells what medical treatments you want or do not want if you had a medical emergency today. The advance directive lets health care professionals know who has the legal right to speak for you if you can't speak for yourself. In most states, if your medical condition changes, you are unable to speak for yourself, and your POLST Paradigm Form no longer makes sense with your goals of care, then your health care professional will look at your advance directive to see who your surrogate is. Your surrogate and health care professional will then work together to update your POLST Paradigm Form so that your goals of care match your current medical condition.

Without an advance directive, and depending on what state you live in, there may not be anyone who can legally make decisions for you, or it may be unclear who that person is.