Advance Directives for Health Care and POLSTs
I am often asked the difference between an Advance Directive for Health Care (ADHC) and a Physician’s Order for Life-Sustaining Treatment (POLST). While both address end-of-life decisions, they do so in different and often complimentary ways.
An ADHC is a legal document in which a person states what (if any) health care measures they want if they are unable to communicate these wishes on their own. An ADHC can (and should) name a health care representative to speak to and direct the physicians in the place of the person creating the document. Such decisions can include whether to withhold or remove life support, food, or hydration. In Oregon, we are mandated to use the form created by the legislature, which is basic in its instructions to say the least. However, we may supplement it with attachments to make the document a more comprehensive one and one which speaks to our personal desires and concerns. ADHCs do not require a doctor or an attorney; to make one effective, it must simply be witnessed by two adults, neither of whom are named as health care agents, your physician, or a health care or residential staff member where the person lives or is receiving services. It may be changed or revoked at any time by the person who created it. Everyone over the age of 18 should have an ADHC and they should be reviewed annually to ensure they remain current with one’s end-of-life decisions.
A POLST, on the other hand, is a medical order completed with one’s doctor. POLSTs address emergency situations in which a person may not be breathing or have no pulse, and both hospital personnel and EMTs will follow them in an emergency. POLSTs specifically address whether a person wants (1) emergency personnel to attempt CPR in the event the person is unconscious, not breathing, or without a pulse, and (2) to go to the hospital, be put on a breathing machine (if necessary), or simply wants to be made comfortable where they are. A POLST must be signed by a doctor or nurse practitioner to be valid. POLSTs can also become part of the Oregon POLST registry, allowing the medical orders in it to be accessed quickly in an emergency. Typically, a POLST is completed by someone who is seriously ill or frail and toward the end of life.
Here is a table which sets out the differences between an ADHC and a POLST:
Both documents are important and have a place in an overall estate plan. Conversations with one’s medical and legal professionals will ensure that the appropriate documents are in place and end-of-life decisions are known and honored.
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