Here is something new to
POLST—MORE ALPHABAET SOUP
Much of medicine today seems
to be broken down into a series of letters,
each representing a disease, treatment, test
or prognosis. We have CBCs, CHF, COPD, PRN,
HCG, and on and on.
One of the newest set of
letters we now encounter is POLST. The letters
themselves stand for Physician Orders for
Life-Sustaining Treatment. That sounds
beneficial, but a closer examination of the
letters shows an unexpected explanation.
A POLST is document filled
with the responses to a series of questions
regarding treatment. The questions are
generally asked of a patient by a
“facilitator” about their treatment wishes.
The patient’s signature or that of a witness
IS NOT REQUIRED AND IS OFTEN NOT SOUGHT.
After the questions are
asked and recorded, the document is presented
to a physician or other designated health care
professional for his/her signature. This is
not necessarily the patient’s own physician,
or any health care professional known to the
patient. The document is then placed in the
patient’s record, frequently as the first
document seen when the record is accessed. The
POLST follows the patient to an extended care
facility and even to his/her own home where
emergency medical technicians must follow the
Many POLST questions subtly
slant toward non-treatment and refusal of
life-sustaining treatment. Filling out a POLST
document may render the agent a person names
as his/her Durable Power of Attorney for
Health Care powerless.
The dangers inherent in the
POLST are clear. If the patient does not sign
the document there is no way to know for sure
that the information given is what the patient
wants. The issue of informed consent becomes
quite “fuzzy” if the patient does not sign
that he/she had really been informed. Patients
are frequently asked to answer questions about
health care when seriously ill and vulnerable.
If the document is attached to the patient’s
records and he or she recovers from the
initial illness, it remains in effect until
voided. The next health care episode may have
a whole different set of needs or the patient
may have changed his/her mind about the
original answers and yet the original answers
stay in effect.
A POLST is not about
ensuring that a patient’s medical wishes
A POLST is not needed
for treatment to be provided.
A POLST is presented at
a very vulnerable time and little time is
provided for thoughtful consideration.
This hardly constitutes informed consent
A prudent course of action
is to be sure that a person executes a Durable
Power of Attorney for Health Care, name an
agent to implement the DOAHC if he/she cannot
and to decline to answer questions or fill out
For more information on end
of life issues, please visit
Diane Trombley , RN,