The POLST in Minnesota - Using it Correctly with Your Advance Directive
A relatively new development in Minnesota is the Provider Order for Life Sustaining Treatment otherwise known as POLST. In the states that have legally adopted the order, it is actually known as the Physician’s Order for Life Sustaining Treatment. In Minnesota, because physician’s assistants and nurse practitioners also provide a significant amount of health care, the term was changed to “Provider Order" to clarify the role other medical professionals play in the process. The POLST has been enacted legislatively in nine states up to now, but not in Minnesota. Rather than pursue a legislative mandate, the Twin Cities Medical Society chose not to leave the ultimate shape of the order to legislative committee. Instead, a foundation was created to assist in educating the public about the need for advance care planning – Honoring Choices Minnesota. Advance care planning combines the concepts of consulting with patients about their choices, usually through a medical facility and working with the patient’s attorney to create an Advance Directive for Healthcare(formerly known in Minnesota as a living will, health care proxy, health care power-of-attorney, among other names). Because there was much confusion as to what this document or documents were intended to accomplish, in 1998 the Minnesota legislature amended the statute to create one document called the Health Care Directive. It combines the essential components of both the Living Will and the Health Care Power of Attorney.
Because the concept is not legislatively mandated in Minnesota, the key to making it known to the public will be education through the medical providers and attorneys serving the patients. The process will begin with advance care planning, initiated through discussions and/or seminars at health care facilities. The patient, working either through their attorney or by themselves, will generate an advance directive. This is a document which reflects the patient’s wishes and in addition to providing instructions on how the patient wishes end of life treatment to be administered, also can address organ donor wishes and treatment of final remains. It is clearly a “patient-directed" document. Under statute, it must:
Be in writing
State the principal’s (patient’s) name
Be executed by the principal with capacity to do so
Be verified by either a notary public or two witnesses, and
Include either a health care instruction or a health care agent or both
Finally, the POLST is an order signed by the personal physician used to translate the patient’s issues. The intent is to translate the advance directive into physician’s orders to increase the likelihood of having the patient’s wishes concerning end-of-life treatment followed. It does not replace the advance health care directive. Its purpose is to supplement it. The difference between the two is that a Health Care Directive is the patient’s end-of-life preferences and the POLST is a doctor’s order signed by a physician.
The Health Care Directive is intended to be a longer term document, which can be amended or revoked at will, but generally provides family members or friends with instructions on the patient’s wishes as well as the names of people willing to step in if the patient cannot act individually. The POLST, on the other hand, is anticipated to be a rather short-term document which will be reviewed frequently by both patient and physician and amended as necessary based on the physician’s judgment.
What action should you take? The intent of all this is to encourage a dialogue about end-of-life issues among family, friends and physicians. If you don’t have any of these documents, consider creating them. The next time you meet with your physician, initiate the discussion. Attend provider informational sessions if offered. If none are offered, find out who is responsible at your health care facility for patient education and suggest the topic. As always, if you need any kind of help or support from us, please call or email, and visit the website Polstmn.org.