What Is a POLST and Do I Need One?

The document most people have never heard of — until they're in a hospital.

If you or someone you love has a serious illness, is elderly and frail, or is living in a care facility, there's a document that may matter more in an emergency than anything else in your estate plan.

It's called a POLST.

Most people have never heard of it until a doctor or social worker hands them one in a hospital room. At that point, the stakes are high and the time is short. Understanding what a POLST is — before that moment arrives — puts you in a completely different position.

What Is a POLST?

POLST stands for Physician Orders for Life-Sustaining Treatment. It's a standardized medical order — signed by both you (or your healthcare agent) and your physician — that translates your end-of-life wishes into specific clinical instructions that follow you across care settings.

You may also see it called:

• MOLST (Medical Orders for Life-Sustaining Treatment) — used in New York and some other states
• MOST (Medical Orders for Scope of Treatment) — used in North Carolina and others
• TPOPP (Transportable Physician Orders for Patient Preferences) — used in some states
• POST (Physician Orders for Scope of Treatment)

The name varies by state. The function is the same.

A POLST is not a legal document like a Living Will or Advance Directive. It is a medical order — with the same weight as any other physician order in a clinical setting. That distinction matters enormously, as you'll see.

How Is a POLST Different from a Living Will or Advance Directive?

This is the most important thing to understand, and the thing most people get confused about.

That last row is the critical one. Emergency medical technicians responding to a 911 call are generally not able to honor a Living Will — it's a legal document, not a medical order, and EMTs are trained to treat and stabilize. But a POLST — because it is an actual medical order — can be followed by emergency responders in most states.

If someone has a POLST that says "do not attempt resuscitation" and emergency responders arrive, they are generally required to honor it. Without a POLST, they are generally required to attempt CPR.

This is why a POLST matters so much for people with serious illness — and why a Living Will alone is often not enough in that situation.

What Does a POLST Cover?

A POLST form is typically one page and addresses three core decisions:

1. Cardiopulmonary Resuscitation (CPR)

If your heart stops and you are not breathing, do you want CPR attempted? Options are typically: Attempt Resuscitation / Do Not Attempt Resuscitation (DNAR).

2. Medical Interventions

If you have a pulse and are breathing, but are in serious distress, what level of intervention do you want?

• Full treatment — all medically appropriate interventions, including ICU care
• Selective treatment — some interventions (IV fluids, limited procedures) but not full hospitalization or ICU
• Comfort-focused treatment — focus on comfort and symptom relief only, minimal intervention

3. Artificial Nutrition

If you cannot eat or drink, do you want a feeding tube? Options typically include: long-term, time-limited trial, or no artificial nutrition.

Some POLST forms also include space for additional instructions or a reference to your Advance Directive.

Who Needs a POLST?

A POLST is not for everyone. It is specifically designed for people who:

• Have a serious illness — cancer, heart failure, COPD, kidney disease, or other conditions with a significant chance of decline or death within a year
• Are elderly and frail — where a medical crisis is a realistic near-term possibility
• Are living in a care facility — nursing home, assisted living, memory care
• Have advanced dementia — where decision-making capacity is already limited
• Are receiving hospice or palliative care
• Have recently been hospitalized for a serious condition

If you are a healthy 55-year-old with no serious medical conditions, you don't need a POLST right now. You need an Advance Directive and a Medical Power of Attorney. A POLST becomes relevant when your health situation changes in ways that make these decisions near-term rather than hypothetical.

The National POLST organization puts it this way: a POLST is appropriate for anyone for whom their physician "would not be surprised" if they died within a year.

How Does a POLST Work in Practice?

The power of a POLST is that it travels with you. It is designed to move across care settings — from home to hospital to nursing facility to hospice — and to be immediately recognizable and actionable by any clinical team.

• At home: If 911 is called, emergency responders see the POLST (typically posted visibly — on a refrigerator, near the bed) and follow its instructions. No CPR if it says DNAR. Transport to hospital for comfort care only if that's what's specified.
• In a nursing facility or assisted living: The POLST is in your medical chart and followed by all care staff. When a crisis occurs, nurses don't have to make judgment calls — the order is clear.
• In the hospital: The POLST is entered into your chart and guides your care team's decisions. It doesn't override your physician's clinical judgment, but it establishes your wishes as a standing order.
• Transitioning between settings: The POLST moves with you. Unlike a verbal statement or even a Living Will, the POLST is designed to be instantly legible and actionable in any clinical environment.

How Is a POLST Created?

A POLST is created through a conversation with your physician — not independently, and not online without physician involvement. This is by design. The POLST requires a medical professional to assess that the form is medically appropriate for your situation and to co-sign as a medical order.

The process:

1. You or your family member (or healthcare agent) initiates a conversation with your primary care physician, specialist, or care facility medical director
2. The physician walks through the form with you and explains what each decision means clinically
3. You make your choices based on your values, your prognosis, and your understanding of the options
4. Both you (or your agent) and the physician sign the form
5. The original stays with you — typically in a visible location at home, or in your chart at a facility

Can a healthcare agent complete a POLST?

Yes, if you lack the capacity to make decisions yourself, your named healthcare agent can complete a POLST with your physician on your behalf — which is exactly why having a Medical Power of Attorney in place is so important.

What Happens Without a POLST

For people with serious illness or advanced age, the absence of a POLST creates a dangerous gap that a Living Will alone cannot fill.

• Emergency responders default to full intervention. Without a POLST, EMTs are required to attempt resuscitation and stabilize — regardless of what your Living Will says, regardless of what your family says in that moment.
• Care transitions become risky. Each time you move from home to hospital to facility, your wishes have to be re-established. Without a portable medical order, something can get lost or overridden in the handoff.
• Your family may be put in an impossible position. If you're brought to the emergency room in crisis and you have no POLST, your family may have to make urgent decisions — under pressure, in real time — that you would have preferred to make yourself in a calmer moment.

POLST and Your Other Documents — How They Work Together

Think of your legal and medical documents as a layered system, each serving a different purpose:

Advance Healthcare Directive / Living Will

Your documented values and general treatment preferences. Created while healthy. Guides decisions over a long horizon. Legal document.

Medical Power of Attorney

Names your healthcare agent. Gives them legal authority to speak for you. Works alongside and enforces your Advance Directive.

POLST

Translates your wishes into specific, immediately actionable medical orders. Created when illness or advanced age makes these decisions near-term. Medical order — not a legal document.

You can — and often should — have all three. They don't conflict. They work together. The Advance Directive and Medical POA provide the foundation; the POLST provides the real-time clinical instruction that emergency and care settings need.

How to Bring It Up with Your Doctor

Many people wait for their doctor to raise the topic. Many doctors wait for the patient to raise it. The POLST conversation often doesn't happen until a crisis forces it.

You can start it:

"I've been thinking about what I would want if I had a medical emergency, and I've read about something called a POLST form. Is that something we should be talking about given my current health situation?"

Or, if you're an adult child raising it on behalf of a parent:

"Mom's primary care doctor — I'm wondering if a POLST form would be appropriate for her at this point. Can we have that conversation at her next appointment?"

Your doctor will tell you honestly whether a POLST is appropriate. If it is, they'll guide you through the form. If it isn't yet, you'll know what changes would make it relevant.

Common Questions About POLST

Related Resources

• Advance Healthcare Directive: Making Your Wishes Known
• Living Will: Your End-of-Life Treatment Preferences
• Financial Power of Attorney: Protecting Your Assets
• Guardianship: When It's the Only Option Left
• Browse all Legal & Financial articles
• Gentreo — Create Your Documents Online