A POLST Paradigm Form does not replace an advance directive — but they work together. While all adults should have an advance directive, not all should have a POLST Paradigm Form.
Both provide information about treatment wishes but they give different information:
The information in both of these documents needs to be discussed with your health care professional and your loved ones.
- Advance Directive: This is called different things in different states (e.g., living will, health care power of attorney) but, regardless of the term, this describes a legal document you use to provide guidance about what types of treatments you may want to receive in case of a future, unknown medical emergency. It also is where you say who can speak for you to make medical treatment decisions when you cannot speak for yourself (called a "surrogate"). All adults should have an advance directive.
- Physician Order for Life-Sustaining Treatment (POLST) Form: This is called different things in different states (e.g., MOLST, MOST, POST— see our map for more information) but, regardless of the term, POLST is a medical order for the specific medical treatments you want during a medical emergency. Only individuals with a serious illness or advanced frailty near the end-of-life should have this form.
They work together! All adults should have an advance directive, but it is only when you are diagnosed with a serious illness or frailty that you should consider a POLST Paradigm Form.
No. A POLST Paradigm Form complements the advance directive - it does not replace it.
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 medial orders but it provides an idea of what treatments you may wish to have. 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. Only someone seriously ill or frail and towards the end of life should consider a POLST Form.
A POLST Paradigm 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 or 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.
|POLST Paradigm Form||Advance Directive|
|Type of Document||Medical Order||Legal Document|
|Who Completes||Healthcare Professional (and patient or surrogate)||Individual|
|Who Needs One||Seriously ill or frail (any age) for whom healthcare professional wouldn’t be surprised if died within 1 year||All competent adults|
|Appoints a Surrogate||No||Yes|
|What is Communicated||Specific medical orders for treatment wishes during a medical emergency||General wishes about treatment wishes. May help guide treatment plan after a medical emergency.|
|Can EMS Use||Yes||No|
|Ease in locating||Very easy to find. Patient has original. Copy is in medical record. Copy may be in a Registry (if your state has a Registry).||Not very easy to find. Depends on where patient keeps it and if they have told someone where it is, given a copy to surrogate or to health care professional to put in his/her medical record.|
No. A POLST Paradigm Form is a medical order that provides medical orders that emergency health care professionals can follow. Since the POLST Paradigm Form is completed only when someone is seriously ill or frail, their diagnosis and prognosis is known and so treatment decisions can be chosen and documented on a POLST Paradigm 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 Paradigm 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 Paradigm 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 patients'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 Paradigm Form is a medical order.
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.