A POLST is a medical order that tells healthcare providers, including emergency responders, exactly what life-sustaining treatments a seriously ill person does or does not want. POLST stands for Physician Orders for Life-Sustaining Treatment, and unlike a general advance directive, it carries the same legal weight as any other doctor’s order the moment it’s signed by a clinician. It was designed in the 1990s in Oregon to help ensure that people with advanced illness or frailty receive care that matches their actual wishes, especially in emergencies when they can’t speak for themselves.
How a POLST Differs From an Advance Directive
Many people assume a POLST is the same thing as a living will or advance directive. They serve related but distinct purposes. An advance directive is a document you write yourself, with or without an attorney, that outlines your general preferences for future medical care and names someone to make decisions on your behalf. It applies broadly across your life and covers hypothetical scenarios. It does not, however, function as a medical order, and it generally does not apply to emergency care.
A POLST converts those general goals into specific, actionable medical orders for your current medical condition. Because it’s a signed clinical order, emergency medical teams are required to follow it. If paramedics arrive at your home and find a valid POLST, they know immediately whether to attempt CPR, use a ventilator, or provide comfort-focused care only. An advance directive alone wouldn’t give them that clarity in the moment.
The two documents work best together. An advance directive serves as the starting point, capturing your broad values and appointing a healthcare agent. A POLST then takes those values and translates them into precise instructions that medical teams can act on without delay.
Who Should Have a POLST
A POLST is not meant for healthy adults. It’s intended for people with serious illness, advanced frailty, or a life expectancy that may be a year or less. That includes people living with advanced cancer, late-stage heart or lung disease, progressive neurological conditions like ALS, or significant age-related decline where a medical crisis could happen at any time.
If you’re relatively healthy, an advance directive is the appropriate planning tool. A POLST becomes relevant when your medical situation has progressed to the point where specific emergency scenarios are no longer hypothetical but likely.
What the Form Covers
A standard POLST form addresses the major decisions that arise during a medical emergency or serious decline. The core sections typically include:
- CPR status: Whether to attempt resuscitation if your heart stops or you stop breathing.
- Level of medical intervention: Whether you want full treatment (including ICU care and intubation), limited interventions (such as IV fluids and basic medical treatments but not intensive care), or comfort-focused care only.
- Artificially administered nutrition: Whether you want feeding tubes if you become unable to eat or drink on your own.
Each section offers clear options rather than open-ended questions, which makes the form straightforward for medical teams to interpret under pressure.
How a POLST Gets Created
A POLST is not something you fill out on your own. It requires a conversation between you (or your surrogate decision-maker) and a healthcare provider, typically a physician, though some states allow nurse practitioners or physician assistants to complete the form. The emphasis is on shared decision-making: your provider explains your current diagnosis, prognosis, and realistic treatment options, and you discuss what matters most to you given that information.
This conversation often involves family members or other people close to you, since they may need to help carry out your wishes or make decisions if you lose the ability to communicate. The clinician then translates your preferences into medical orders and signs the form. In over 30 states, your signature (or your surrogate’s) is also required for the form to be legally valid. Even in states where a patient signature is only recommended, the form must identify who provided consent.
A POLST can be updated or revoked at any time. If your condition changes or your preferences shift, you and your provider can have another conversation and complete a new form.
Why It Applies in Emergencies
The key advantage of a POLST is portability. The form is printed on brightly colored paper (typically bright pink or green, depending on the state) so it’s easy to spot. It travels with you between care settings: from home to the hospital, from a nursing facility to an ambulance. Emergency responders are trained to look for it and follow it.
Without a POLST, paramedics and ER teams default to providing full, aggressive treatment, including CPR, intubation, and ICU admission. For someone with a terminal illness who has decided they want comfort care only, that default can mean receiving exactly the interventions they hoped to avoid. A POLST prevents that disconnect by putting a valid medical order in the hands of whoever responds to the emergency.
Different Names Across States
While the concept is the same nationwide, the form goes by different names depending on where you live. About 35% of states use the name POLST. Others call it POST (Physician Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), or MOST (Medical Orders for Scope of Treatment). Some states have created their own variations: COLST in Vermont, LaPOST in Louisiana, DMOST in Delaware, and so on. In total, at least 13 different names are in use across the country.
Despite the naming differences, the forms share the same core structure and purpose. If you’re unsure what your state calls its program, searching your state name along with “POLST” will typically point you to the right resource. The National POLST Collaborative maintains a directory of state-specific programs and forms.
The Role of Surrogates
One important distinction between a POLST and an advance directive is what happens when a person can no longer make their own decisions. A surrogate, such as a spouse, adult child, legal guardian, or healthcare agent named in an advance directive, cannot write an advance directive on someone else’s behalf. But a surrogate can participate in and consent to a POLST when the patient lacks the capacity to do so themselves. This makes the POLST a practical tool for families navigating end-of-life care for a loved one with advanced dementia or another condition that impairs decision-making, as long as the conversation reflects the patient’s known values and previously expressed wishes.