Transition Planning Information

What is the POSLT form?


The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program provides comprehensive, portable end-of-life physician orders that convey a patient’s wishes regarding life-sustaining treatment and resuscitation. More than 40 states have adopted these orders in various forms using various acronyms. Check with your state government for more information.

Arizona has no POLST program but permits patients, rather than physicians, to initiate and validate a pre-hospital advance directive without the signature of a physician or other health care provider.

Be aware that power of attorney designations, wills, trusts and other related documents are powerful legal instruments. It is recommended that you contact a private attorney for assistance with these and other serious legal matters.

What is a Pre-Hospital Directive (sometimes called an Orange Form)?

Emergency medical service personnel (or “911” responders) are generally required to resuscitate and stabilize patients until they are brought safely to a hospital. If needed, you may receive cardiopulmonary resuscitation (CPR), which is treatment to try to restart a person’s breathing or heartbeat. CPR may be done by pushing on the chest, by putting a tube down the throat or by shocking the heart in an attempt to restart it.
If you do not wish to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing, you must complete a special Advance Directive document called a “Pre-Hospital Directive.”

Go to http://www.azsos.gov/adv_dir/HCD/Questions.htm for more information.

More general information about the Physician Orders for Life-Sustaining Treatment

More thorough than a simple do not resuscitate or do not attempt resuscitation (DNR/DNAR) order, the POLST or similar form allows for decision making by the patient regarding resuscitation, hospital transfer, comfort measures, antibiotic use (in some states), and hydration and nutrition.

The POLST form supplements (but does not supplant) other advance directives. While statutory advance directives require witnesses and often notarization, POLST forms only require the signatures of the patient (or appropriate surrogate) and a clinician to be valid. Physicians must sign the form in some states, while midlevel providers may sign the form in others.

The POLST form (which can vary from state to state) has several sections with check boxes addressing various treatment options, such as resuscitation measures. Another section has check boxes for medical interventions, allowing the patient to choose among comfort care alone (including hospital transfer only if current institution is unable to provide such care), limited additional interventions (intubation, invasive ventilation), or full treatment.

POLST orders are not portable from state to state because medicine is regulated at the state rather than federal level. Some state legislatures, however, have chosen to uphold the validity of signed out-of-state POLST forms; others have not, or remain silent on this issue.

POLST orders complements but does not replace an advance directive. An advance directive is not always available when needed, and does not carry the weight of a physician’s orders.

For more information, go to the national POLST Paradigm website, www.polst.org It has a variety of videos, forms and answers to frequently asked questions.

Understanding Treatment Options

When a decision about your care needs to be made, it is important to have enough information to make an informed decision.

Decisions should be made with full awareness of the risks, benefits, and expected outcomes of treatment. Treatments are considered helpful if they offer cure, relieve suffering, restore functioning or enhance quality of life. The same treatment can be considered harmful if it causes pain or prolongs the dying process without offering benefit.

If you do not understand medical terms or options being discussed, ask questions.

When weighing the benefit and burden of treatment options, ask your physician if the treatment will make a difference, what the expected side effects are and how will it affect your quality of life.

The decision to refuse treatments and life support is a personal one.

It is legally and ethically appropriate to stop a treatment that is no longer effective and is only prolonging the dying process. If death is the result, it is the underlying disease, not the withdrawal of treatment that causes the death.