Harwer M.D. Partners in Health

Physician Orders for Life Sustaining Treatment (POLST)


What's the right level of care at the end of life? Even for the very ill the answer is not always "more" or repeated and painful heroic attempts. The pink POLST form helps medical staff respect patients' wishes in their final days. All too often families fail to have conversations about the intensity and type of medical interventions patients want at the end of life. In part this is because death is not easily accepted; it's also due to a health care system that seldom asks patients what they want. Yet without these conversations, and a way to document them, patients can end up on a runaway medical train, undergoing painful, ineffective, unwanted and expensive treatments while their psychological, emotional and spiritual needs are poorly addressed.
To help patients have their say if they are unable to speak, CHCF supports the use of Physician Orders for Life-Sustaining Treatment (POLST). POLST is a standardized medical order form that indicates whether a seriously ill patients does or does not want the specific types of life-sustaining treatments. Unlike a Health Care Directive, both the patient and her/his physician signs the California POLST and it becomes a set of medical orders. POLST form travels with the patient as part of her/his medical record and must be honored across all care settings. When used with an Advance Directive(which names a proxy decision maker) POLST reduces unwanted or medically ineffective care, reduces patient and family suffering, and ensures that patients' end of life wishes are honored.
Currently 32 states implemented POLST or are developing similar programs. A California law in effect since 2009 requires that POLST be honored in all care settings and gives immunity to providers who honor a POLST document in good faith.
Since August 2007, CHCF has supported POLST adoption by:

Leadership and oversight of these activities is provided by the Coalition for Compassionate Care of California, with support from consultants and others. The Coalition supports local groups to promote adoption of POLST by hospitals, skilled nursing facilities, emergency medical services, and home health care agencies.

Over the past four years CHCF funded these coalitions (*funding through 2012):

For more information on POLST see the links below.

Related CHCF Pages

Press Release 1/29/09

Press Release 7/02/10

External Links

Having to Think About the Unthinkable (Steve Lopez, LA Times, 12/14/11)

National POLST Paradigm Web Site

California POLST Web Site

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Read more: http://www.chcf.org/projects/2008/physician-orders-for-lifesustaining-treatment-polst#ixzz1h1Vzqr7B