Expert Advice When You Need It Most
How to Complete the "P.O.L.S.T./Physician Order" form with Your Doctor ~ and WhyWritten by: Carol Ann Hunter Peters Reputation Level 8
Posted about 3 years ago. Applies to California, 1 helpful vote, 0 comments
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If I have an AHCD/Advance Health Care Directive or POA/Power Of Attorney for Health Care, why do I need a P.O.L.S.T.?Because the P.O.L.S.T. gives your Doctor specific instructions about what to do in any one of 4 possible situations! We often name a Health Care Agent in our AHCD/POA forms, but neglect to provide instructions about our desired medical choices other than "Will you take care of it"? What does "It" mean? How is CARE to be taken? Considering these specific medical options in advance gives specific instructions to medical personnel, and so enables medical staff to enact your wishes as specifically as you give them. Let's look at the choices available to you: 2
A. If you have no pulse and are not breathing, do you want a CPR or DNR Order?If you are not in cardiapulmonary arrest, then this item is not an issue. If you ARE, however, then making choices in advance of need is helpful. RESUSCITATION attempts to restart the heart beat and breating of a perons who has no heatbeat and has stopped breathing. Typically this involved 'mouth-to-mouth' breating and ofrceful pressure on the chest, to try to restart the heart. Resuscitation may also involve electric shock (defibrillation) or a plastic tube down the throat into the windpipe to assist breathing (intubation). "DNR" is a medical order by a Doctor NOT to attempt resuscitation because it is unlikely to help the patient (given the patient's condition) or the patient does not want it. 3
B. If you have a pulse and/or are breathing, what MEDICAL INTERVENTIONS do you want?For COMFORT MEASURES ONLY, the focus of care is on the main goal of keeping the patient comfortable (instead of on medical interventions that may prolong life). Use of oxygen, suction and manual treatment of airway obstruction are done as needed for comfort. But you will not be transferred to hospital for life-sustaining treatment, unless your comfort needs cannot be met in the current location. LIMITED ADDITIONAL INTERVENTIONS include the care described above, PLUS medical treatment, IV fluids and cardiac monitor as indicated, but NOT intubation, advance airway interventions or mechanical ventilation; you will be transferred to the hospital if indicated, but avoid intensive care; FULL TREATMENT includes the care described above, PLUS intubation, advanced airway interventions, mechanical ventilation and cardioversion as indicated; you will be transferred to the hospital if indicated, including intensive care. 4
C. Do you want ANTIBIOTICS?Antibiotics fight infections (ex: pneumonia) but may only prolong the death of a person who is terminally ill, and so may prolong their suffering. For example, if a cancer patient who has been facing chemotherapy or radiation catches pneumonia, the cancer patient may make different medical treatment choices for the pneumonia (which used to be called 'the Old Man's Friend") than for the cancer. You can decide if you want NO antibiotics, so that other measures are used to relieve symptoms. Or you can determine when infection occurs whether (or not) to use or to limit the use of antibiotics. OR you can request use of antibiotics if your life can be prolonged. 5
D. Do you want ARTIFICIALLY ADMINISTERED NUTRITION?Medical staff always offer food by mouth, if feasible. But sometimes that is not possible. For example, when a dementia patient loses the ability to swallow, then other chocies may need to be made. Fluids and liquid nutrients (formula) can be given through a tube in the nose that goes into the stomach or through a tube placed directly into the stomach (by a surgical procedure). Giving nutritiion by feed tube near the end of life is controversial because doing so may be beneficial or hamful, depending on the patient's condition as well as the patient's wishes: Some people want NO artificial nutrition by tube ever. Others want a defined trial period for artificial nutrition by tube. Still others want long-term artificial nutrition by tube, until they finish writing their symphony or biography or other opus. 6
E. Why does the DOCTOR sign this form?The Patient's DOCTOR signs this form to make it a (portable) "DOCTOR'S ORDER": then medical staff can implement these Orders wherever the patient is located, regardless of whether (or not) the signing doctor has admitting privileges at that facility. The law allows this form to become a PHYSICIAN ORDER regardign LIFE-SUSTAINING TREATMENT (hence the nickname P.O.L.S.T.). This can eliminate delay and so sooner provide more efficient ~ and so more effective ~ health care. However, a Doctor does not HAVE to sign this form if s/he thinks that the Patient does not understand the options presented. Even a person With Capacity might fail to understand some of these medical terms, which is why a conversation is necessary, between the Doctor and Patient. This conversation may require more than one short HMO conference to accomplish. 7
WHO signs for the Patient?The PATIENT can sign this form, unless the Patient has lost capacity, is unable to provide Informed Medical Consent (in advance of treatment); In that case, this form can be signed by the Patient's Health Care Agent or Court-appointed Conservator. For a minor, the minor's Parent(s) can sign the form, and in event of a dispute, would be filing in the Probate Court and counsel would be appointed for the minor. 8
How is the form used?This form is complete only after the DOCTOR SIGNS IT, so the Doctor should have an original, in 'bright pink' so that it is easily found in the Patient's chart. Photocopies and FAXEs of the signed POLST form are legal and valid, but use of the original form is strongly encouraged. Know where it is and document your estate-planning file about who has it; inform your Health Care Agent(s) by giving each of those persons a copy of it, with your Doctor's name and phone number. 9
Can the form ever be changed?The P.O.L.S.T. form should be reviewed periodically. Often keeping a copy with your tax records, for once-a-year review of all financial and personal issues (Will, Trust, nominations) provides an automatic review mechanism. The P.O.L.S.T. should be reviewed whenever the Patient/Principal is transferred from one care setting or care level to another, or when there is a substantial change in the person's health status, or the person's treatment preferences change. When treatment preferences change, draw a line thourgh sections A, B, C, D, or E and write "VOID" in large letters. Additional ResourcesMore information is available at the website for the Californai Coalition for Compassionate Care aka CCCC. Related Questions2 Attorney answers: 
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