POLST 2: Honoring End-of-Life Wishes

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Max Diamond, M.D., Esen Sainz, J.D., MPH, Kendra Oliver, MBA

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Definition

1. California launched the Physician Order for Life Saving Treatment (POLST) Form on January 1, 2009. Today, the POLST Form remains the standard method of advanced medical care planning for persons with advanced illness or frailty near the end of life.
2. The POLST Form has facilitated conversations about patients’ end-of-life wishes and allowed health care providers to document those wishes more clearly in advance.
3. In an emergent situation, the design of the POLST Form provides a comprehensive overview  that lists first the patient’s decision on Cardiopulmonary Resuscitation (CPR). Over one decade of in-field experience, when completing the POLST form with patients, has taught physicians that the most natural conversation with patients and their families is to start at the bottom of the form (identifying the Legally Recognized Decision Maker), and then to work to the top of it (CPR).

Over its history, utilization of the POLST Form in California has given us a proven benchmark for the standard of health care.  The patient can express end-of-life wishes more clearly than ever before its implementation. Thanks to POLST, important end-of-life conversations have taken place routinely in offices, hospitals, and nursing homes.  

(This article is part in a series on the proper use of the POLST Form. View whole article and references.)