Cheri L. Elson and Allen G. Drescher, Retired
SERVING ASHLAND AND SOUTHERN OREGON SINCE 1973
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Advance Directives and POLSTs

I am often asked the difference between an Advance Directive for Health Care (ADHC) and a Portable Order for Life-Sustaining Treatment (POLST).  While both address end-of-life decisions, they do so in different ways.

An ADHC is a legal document in which a person states what health care measures they want if they are unable to communicate on their own.  An ADHC names a health care representative to speak to and direct the physicians in the place of the person creating the document.  In Oregon, we are mandated to use a specific form, which is basic to say the least.  However, we may supplement it so that it speaks to our personal desires and concerns.  ADHCs do not require a doctor or an attorney; it must be either notarized or witnessed by two adults, neither of whom are named as health care agents.  It may be changed or revoked at any time.  Everyone over age 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 is a medical order completed with one’s primary care provider.  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.  A POLST must be signed by a Health Care Professional (defined in the POLST itself) 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:

Advance Directive
A Voluntary Legal Document

POLST
A Voluntary Medical Order

For all adults regardless of health status at any age

For those with advanced illness, or frailty, or a limited prognosis at any age, depending on health status

1) Appoints a legal decision-maker
2) Memorializes values and preferences
3) Is signed by the patient

Is a specific medical order and is signed by a Health Care Professional

Provide for theoretical situations in which a person may not have capacity for decision making

Provides for likely events that can be foreseen

Guidelines for imagined future situations which may arise and for which a person may have preference for a particular kind of care plan

Specific medical orders addressing defined medical interventions for situations that are likely to arise given the patient’s health status and prognosis

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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