POLST stands for Portable Orders for Life-Sustaining Treatment. It is a medical form that translates a seriously ill person’s treatment wishes into actual doctor’s orders, so emergency responders and hospital staff know exactly what to do if that person can’t speak for themselves. Unlike a general wish list, a signed POLST carries the same legal weight as any other medical order written by a physician.
What a POLST Form Covers
A standard POLST form addresses three major categories of emergency medical care. The first section covers cardiopulmonary resuscitation (CPR): whether to attempt it or not if the person’s heart stops. The second section covers broader medical interventions, including whether to use breathing tubes, ventilators, or advanced airway support. This section also addresses preferences around antibiotics and IV fluids. The third section covers artificially administered nutrition, giving three options: no tube feeding, a trial period of tube feeding, or long-term tube feeding.
Each section requires a clear selection. If any section is left blank, medical teams are instructed to provide full treatment for that category until they can get clarification. This design ensures there’s never ambiguity when seconds count.
Who Qualifies for a POLST
POLST forms are not for healthy adults planning ahead. They’re intended for people of any age who have a serious illness or frailty, typically when a healthcare professional would not be surprised if the patient died within the next year or two. That includes people with advanced cancer, progressive neurological diseases, severe organ failure, or significant frailty from aging.
A POLST must be created through a shared decision-making conversation between the patient (or their surrogate decision maker) and a qualified clinician. This isn’t a form you download and fill out on your own. The conversation covers the patient’s current diagnosis, prognosis, and realistic treatment options, helping the patient understand what life-sustaining interventions actually involve and what outcomes to expect. Timing matters: clinicians are encouraged to initiate these conversations when the patient is still well enough to participate meaningfully, and to include family members when appropriate.
Once the conversation is complete, the form must be signed by a physician or, in some states, a nurse practitioner or physician assistant. That signature is what transforms it from a preference document into a legally binding medical order.
How POLST Differs From an Advance Directive
People often confuse POLST with an advance directive (sometimes called a living will), but they serve different purposes and work in different situations.
- Legal authority: An advance directive records your preferences and names a healthcare agent to make decisions for you. A POLST is a set of actual medical orders signed by a clinician.
- Who can create one: Any adult can write an advance directive, regardless of health status. A POLST is only for people with serious illness or frailty.
- Emergency use: Advance directives generally do not apply during emergency care. POLST forms are specifically designed to guide emergency responders in the field.
- Surrogate involvement: A surrogate cannot create an advance directive on someone else’s behalf. Surrogates can participate in and consent to a POLST when a patient lacks the capacity to make their own decisions.
- Who writes it: You can write an advance directive yourself, with or without an attorney. A POLST requires a clinician’s involvement and signature.
The two documents complement each other. An advance directive covers the broad picture, including naming someone to make decisions for you. A POLST provides specific, actionable orders for the medical situations most likely to arise given your current condition.
How It Works in an Emergency
The entire point of a POLST is that it’s portable and immediately recognizable. The form uses a standardized format, typically printed on brightly colored paper, so paramedics and emergency room staff can find it quickly and interpret it without delay. In a medical emergency, when there’s no time to locate family members or dig through medical records, a POLST tells the team exactly which interventions the patient does and does not want.
The specifics of how emergency medical services handle a POLST vary by state. In some states, paramedics can follow POLST orders directly. In others, like Pennsylvania, EMS providers must first receive confirmation from a medical command physician before following the orders on the form. Non-EMS responders (such as nurses in a care facility) generally initiate whatever treatment the POLST specifies and then contact the patient’s physician as needed.
State-by-State Differences
POLST is a national movement, but it’s implemented at the state level, and that creates real complications. Every state’s form looks different. Some states don’t even call it POLST: Massachusetts uses MOLST (Medical Orders for Life-Sustaining Treatment), and other states have their own variations.
More importantly, states have different laws about whether they’ll honor a POLST form signed in another state. Some states, like Rhode Island and Vermont, have statutes that explicitly allow health professionals to honor out-of-state forms. Others explicitly do not, and many exist in a legal gray area. This means a patient who splits time between two states, or who travels through a third state for medical treatment, may need a separate POLST form for each state to ensure their wishes are followed everywhere. It’s an acknowledged problem that patient advocates and policymakers are working to address, but for now, portability across state lines is not guaranteed.
Changing or Canceling a POLST
A POLST is not permanent. Because it reflects your current medical situation and goals, it should be reviewed whenever your health changes significantly, when you’re transferred between care settings, or simply when your preferences evolve. You can request changes at any time.
Updating or revoking a POLST follows the same process as creating one: a conversation with your clinician and a new signed form. A patient with decision-making capacity can also verbally revoke their POLST. The old form should then be clearly voided or destroyed so there’s no confusion if emergency responders encounter it later. If a surrogate decision maker was involved in the original POLST, they can also participate in updating it, provided the patient still lacks the capacity to do so themselves.