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POLST Form Updated

Posted Tuesday, May 27, 2014 by John S. Palmer

Washington’s Physician Orders for Life Sustaining Treatment (aka the “POLST” form) was updated last month, in part to clarify that it does not replace a health care directive or living will.

The POLST form has two primary purposes: to convert a patient’s treatment wishes into actual physician’s orders, and to do so in a manner that can easily follow the patient from one care setting to another.

As an estate planner, I am often asked whether a client with a POLST still needs a health care directive (also known as a living will) or health care power of attorney. The answer is that a good basic estate plan should always include both a health care directive and power of attorney, whereas only certain clients need a POLST form.

A health care directive permits the principal to direct, in advance, that all medical treatment (and artificial nutrition and hydration if so desired) be withheld or withdrawn if the principal is ever diagnosed to be suffering from a permanent unconscious condition (i.e., a coma or persistent vegetative state with no reasonable probability of recovery) or a terminal condition (defined as an incurable and irreversible condition that will cause death within a reasonable period of time and where the application of life-sustaining treatment would only prolong the process of dying).

If the principal becomes unable to make his or her own medical decisions, the terms of the health care directive can be carried out by a health care agent authorized to make medical decisions in the principal’s durable health care power of attorney.

These two documents can often be quite lengthy as estate planning attorneys like to cover all the bases regarding potential future treatment (including routine or non-emergency treatment) and the health care agent’s authority to do various things.

The POLST form is intended to summarize the principal’s wishes regarding emergency and end-of-life treatment as already expressed in his or her estate planning documents, in a form that emergency medical personnel can follow immediately. Therefore, it is intended for persons with serious illness or otherwise likely to need emergency medical treatment; is printed on bright green paper, so it can be easily spotted in an emergency (though a photocopy or faxed copy is valid); and is limited to one piece of paper, so emergency personnel do not need to wade through a lengthy estate planning document trying to figure out whether to perform CPR.

To help clarify these points, language was added to the POLST form last month stating that it “is usually for persons with serious illness or frailty.” And in recognition of the fact that the POLST is not intended to replace or negate the need for a health care directive or power of attorney, language was also added stating: “The POLST does not replace an advance directive. An advance directive is encouraged for all competent adults regardless of their health status.”

More information about the POLST can be found at the WSMA website. It includes a link to a sample POLST form, but to be effective it must be completed and signed by a physician, certified physician’s assistant, or advanced registered nurse practitioner.

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Law Office of John S. Palmer11911 NE 1st St, Ste. B204,Bellevue, WA 98005-3056