Some may need more than an advance directive.

Advance directives can be misinterpreted, misplaced, or disregarded. The advance directive tells healthcare professionals generally what types of treatment you may want if you are in a coma or have a terminal diagnosis and cannot communicate, as well as, tells them who is allowed to make your healthcare decisions.

When you can’t speak for yourself, your healthcare team will review your advance directive and talk to your surrogate to make healthcare decisions. If you are found unresponsive, it does not tell emergency personnel how to respond and how to treat you.

Advance Directives are not medical orders.

An advance directive, however, may not fully meet the needs of all patients. For a patient who is worried about receiving inappropriate or unwanted care, a medical order may be needed. This is where a POLST comes in.

A POLST is a medical order for healthcare professionals.

POLST stands for Physician Order for Life Sustaining Treatment. It is a medical order that directs healthcare professionals on what to do—without having to consult your healthcare surrogate. It tells them what to do regarding CPR, hospitalization, intubation, mechanical ventilation, antibiotic treatment, and artificial nutrition/hydration.

Advance Directives and POLSTs work together.

The DNR orders and POLSTs do not replace advance directives. The documents work together. Everyone should have an advance directive, and only some people should consider a DNR order and/or POLST. You may want to have a DNR order and/or POLST if you:

• have specific wishes about your end-of-life care;
• are ready for a natural death;
• have a terminal or critical illness; or
• are at significant risk for cardiac or respiratory arrest.

Healthcare professionals must respond quickly if/when they find you unresponsive. They will not have time to review your advance directive, and in the absence of clear orders to direct them otherwise, they must provide you with all possible life-saving measures to keep you alive. If you have a POLST, your healthcare providers should follow what your order says.

Since DNR orders and POLSTs are medical orders, they must be completed and signed by a physician. If you are interested in learning more about these medical orders, please contact your physician. 

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