Why Does POLST Work?

The most important aspect of POLST (Physician Orders for Life Sustaining Treatment) is that they work. Living wills and advance directives lack the teeth to be effective. One of the major differences with POLST is that they must be signed by a medical professional. So far, no litigation has come from use of POLST. Most likely, this is due to several factors. 

Since they must be signed by a physician, nurse practitioner, or physician assistant, they are legal documents. The POLST form takes on the same validity as does any doctor’s prescription or written order. Additionally, the form is then signed either by the patient or a family member. This assures that the patient and next-of-kin are in agreement with these orders. Therefore, unlike the ambiguity that comes with the use of living wills, POLST offers a clear cut method of stating the patient’s end of life decisions. 

How the law fits in with POLST

Sadly, there are numerous examples of families disputing the enforcement of living wills. This is why when an elderly patient comes in via ambulance from a nursing home, the emergency physician never looks at a living will, assuming that this patient is one of only 20 percent of the elderly that has one, and decides to enforce it. In most states, including Pennsylvania, living wills do not have to be notarized. This allows for the possibility that the living will could be illegitimate. 

The possibility that multiple living wills exist with different end of life decisions noted. With the use of POLST, the signed original copy must always accompany the patient. In the event that the patient or family chooses to change the POLST form, the originally POLST form must be voided. Only then can a new POLST be created. This assures that the current wishes of the patient and family are honored. 

What is the bottom line with POLST?

     In every study done since the inception of POLST over twenty years ago, patients and families report favorably on its use. Again, in every study using POLST, patient and family end of life decisions are honored over 90 percent of the time, often 99 percent of the time. Comparatively, in studies with the use of living wills, they show almost zero compliance. 

      We all die. However, what we can do for our loved ones is help to ensure that they are comfortable at the end of life.  Most older Americans prefer to die in the surroundings that they live in, whether it is at home, in hospice, in a nursing home. They do not want to go to a hospital for their last breath. With POLST, we can ensure that we do honor their last wishes.