For people with limited life expectancy there is another type of advance directive that serves as a medical order, signed by the patient and their physician (Or NP, PA), which can let emergency responders or emergency room physicians know what treatment the person wants.

POLST stands for Physician Orders for Life-Sustaining Treatment (in some states, it’s called MOLST, MOST, or POST see POLST.org). 

It is: 

• A medical order, (different from a living will) 

• Completed by a healthcare provider (doctor, NP, or PA) with input from the patient or a healthcare proxy 

• Meant for people who are seriously ill or frail, often in the last few years of life 

The form may have different names depending on your state, but they serve the same goal: Making sure your loved one gets only the care they want. They are most often used when people would like to limit care provided and make this clear to all healthcare providers. For example, this document might say the person does not want CPR or to have a breathing tube inserted or that they don’t want antibiotics. These orders can be updated and changed as illness progresses. They can also be signed by a health care proxy, when one is appointed, once it has been determined that a patient can no longer speak for themselves (i.e with advanced dementia) 

One important thing to note is that even if you are named the healthcare proxy, without a POLST, emergency responders don’t have to take your input since they cannot rely on the surrogate decision maker until a physician determines the patient cannot make decision for themselves. Without this type of order many caregivers are left to plead with first responders not to provide unwanted treatments. 

It clearly states: 

What treatments should or should NOT be given, such as: 

• CPR (cardiopulmonary resuscitation) 

• Intubation or ventilation 

• IV fluids or Antibiotics 

• Hospitalization vs. staying at home 

Preferences about level of care: 

• Full treatment (everything possible) 

• Selective treatment (some interventions but not aggressive) 

• Comfort-focused care (symptom relief, no hospital transfers) 

POLST is most useful when: 

• A person is in the last year(s) of life 

• They have a serious illness, chronic disease, or advanced frailty 

• They want to avoid unwanted medical interventions 

• Clear preferences for care may be needed by emergency responders or emergency room staff 

Unlike an advance directive, POLST is actionable immediately—paramedics and ER staff are legally required to follow it, even outside of a hospital. 

Advance Directive

• Personal legal document 

• For any adult

• Appoints healthcare proxy & states general wishes 

• Not always followed in emergencies

POLST

• Medical order 

• For people with serious illness or frailty 

• Gives specific medical orders

• Must be followed in emergencies

Many people have both: the advance directive for general planning, and a POLST for immediate action based on current health. 

If you are concerned your loved-one may receive unwanted care in an emergency:

• Ask their primary care doctor or palliative care team if it’s time to complete a POLST. 

• Keep the original POLST in a visible location at home (on the fridge or on the bedroom wall). 

• Give copies to the healthcare proxy, care team, and any facility (like a nursing home). 

• POLST forms can be revised or voided at any time if wishes change. 

• If 911 gets called, take the POLST to the ER with you