Rebuttal to proposed POLST replacement (MOELI) published in JAMDA

A rebuttal to the September 2017 editorial “Standardizing Protection of Patients’ Rights From POLST to MOELI (Medical Orders for End-of-Life Intervention)” by Richard B. Stuart, DSW, ABPP, and Stephen Thielke, MD, MS, MA, was published in JAMDA (Journal of the American Medical Directors Association).

Authors Susan Hickman, Alvin (“Woody”) Moss, Karl Steinberg, Charles Sabatino, and Amy Vandenbroucke, in their response, “Proposed POLST replacement creates more problems than it solves,” point out that the National POLST Paradigm Task Force maintains standards for POLST Paradigm programs, built on decades of experience. They also explain multiple concerns with the proposed MOELI. The below is excerpted from the article:

We have concerns about the practicality, feasibility, and appropriateness of the following ideas proposed by the authors:

  1. Creating a nationally standardized form: Although the authors acknowledge that variability among state POLST forms is due to differences in state laws and regulations, they seem unaware that their proposed MOELI form faces substantial legal barriers from those same variations. It is unclear why the authors think MOELI’s legislative pathway would be different or easier than the experiences of state POLST programs or have a different outcome.
  2. Expanding the MOELI-eligible population of patients to everyone over age 80: The NPPTF promotes the use of the POLST Paradigm for seriously ill or frail patients for whom death would not be unexpected because the orders, once signed, become the active plan of care.
  3. Increased complexity of MOELI: The authors criticize POLST as “easily misunderstood” and “difficult to interpret,” yet propose a form that is more complicated and more confusing. MOELI introduces the potential for conflicts with its “additional orders” menu of treatment options that permits selection of treatments that are incompatible, making interpretation unnecessarily difficult.

Drs. Stuart and Thielke’s intentions to improve POLST are most appreciated. A collaborative approach to improving POLST is encouraged and will hopefully make the best use of resources in reaching the common goal of honoring patient end-of-life treatment wishes.

We appreciate that Drs Stuart and Thielke sought to stimulate discussion about the POLST form so that, as they suggest, institutional resources and educational efforts will be mobilized to ensure that the treatment patients receive at the end of life is the treatment they want. Clinicians, researchers, and policymakers interested in improving the POLST Paradigm model are encouraged to work collaboratively with their respective state POLST programs.”


Stuart, RB and S Thielke (2017). Standardizing Protection of Patients’ Rights From POLST to MOELI (Medical Orders for End-of-Life Intervention), JAMDA. 18(9):741–745. doi:10.1016/j.jamda.2017.04.022 (limited access).

Hickman SE, AH Moss, KE Steinberg, CP Sabatino,A Vandenbroucke (2017). Proposed POLST Replacement Creates More Problems than it Solves, JAMDA. 18(12):1092–1093. doi:10.1016/j.jamda.2017.09.024 (limited access).