overview

State Authorized Portable Orders

- Washington: POLST (Physician Orders for Life Sustaining Treatment)

- Idaho: POST (Physician Orders for Scope of Treatment)

- Montana: POLST (Provider Orders for Life Sustaining Treatment)

- Oregon: POLST (Physician Orders for Life Sustaining Treatment)

For video on POLST, click here.

At the end of your life do you want chest compressions (CPR), a breathing tube put down (intubation), tubes put in to give you fluids and nutritional support, antibiotics, and other life sustaining treatments? If you do, then for how long? Do you just want your pain controlled and other comfort measures? Some people never try to answer these questions. Failure to do so may mean your family and doctors are left to try to figure out what you want done and for how long.

To respect your choices about what you want, POLST forms have been developed for the dual purposes of encouraging you and your family to discuss end-of-life-care choices, and then transform your decisions into a form. You sign the form. Your physician signs the form. POLST gives your decisions the authority of a physician orders - a form that will be honored in all health care settings.

The actual title on the form varies by state. Go to the maps, above, and click on your state for your form.

Yes, there are several forms and that may seem confusing. There is a “Living Will”, and a “Durable Power of Attorney for Health Care”. These forms also go by the name “Advance Directive.” If you have not completed these forms, then ask your VA care provider (doctor, nurse practitioner or physician assistant) or team nurse or social worker for the forms. If you need help filling them out, then please ask for help.

Advance Directives help give guidance for your care when you are unable to speak for yourself for medical conditions that may occur in the future. POLST is set of physician orders for your current medical conditions.

You should complete a POLST form if your life is likely to end within the next year – perhaps you have a diagnosis of advancing cancer or perhaps severe heart or lung disease. This form sets forth your decisions on what you want for life-sustaining treatments for your current medical condition, is a doctor’s order, and is portable.

It’s your decision: end-of-life choices

Each state’s form generally is organized by sections. These sections generally include whether you want CPR or other resuscitative measures, long-term fluid and nutrition, antibiotics, and other measures. You sign and date the form. Your doctor signs and dates the form. Only when both signatures appear on the form does it become active.

Signed by you and your care provider: a doctor’s order

If possible, then you and your doctor should fill out the form together. If you are not sure, ask questions. You can take the form home and discuss it with family and friends. When you’ve completed your form, you will sign. A doctor will also sign (currently, VA policy does not allow nurse practitioners or physician assistants to sign). Both signatures – you and the doctor – are required (except in Oregon where the patient’s signature is optional). Otherwise the form will not be honored. If this form is for someone who can’t make decisions (perhaps your husband has Alzheimer’s dementia or a stroke), then you may be able to sign the form as a “surrogate” for your husband, wife, parent, or other relation. The surrogate would be signing verifying that this represents the patient’s wishes.

Portable: the form goes with you

The form is portable and goes with you. When the paramedics come to your door, they know to look for POLST – so locate the form where paramedics will see it (such as on your refrigerator or above your bed). If you come to the emergency room the form travels with you. Even if we have your form, we will still ask you about end-of-life choices before we write our orders to admit you to the hospital wards. When we discharge you from the hospital, the form will go with you to your home, nursing home, hospice unit, or wherever you go. The form is portable. It goes where you go. It is an expression of your values and specific orders from a doctor (also signed by you) for life-sustaining treatment.

A little history: Spokane VA and State-Authorized Portable Orders

For Washington State, the state’s POLST form started with concerns about our veterans and what happens to them when they leave the VA hospital here in Spokane. More specifically: will veterans’ decisions about what they want and don’t want be honored by paramedics, nursing home staff, and others.

In the early 1990s the Spokane VA convened an ethics committee that included social workers, surgeons, respiratory therapists, nurses, and physicians. We developed the program so that you can complete your Advance Directives. But we were concerned about what happens to our veterans when they leave the hospital – the fragmentation of health care that could result in your choices about end-of-life care not being carried out. We sponsored a regional ethics conference, including staff from the VA’s National Ethics Center. From that meeting began RENEW – the Regional Ethics Network of Eastern Washington and Northern Idaho.

In the late 1990s RENEW began drafting a POLST form for Washington State, modeled on a form used in Oregon. We piloted the form in two eastern Washington counties, Spokane and Whitman. Then, with the help and support of the Washington State Medical Association, state agencies and many organizations and individuals, POLST became available statewide.

In July 2007 the Department of Veteran Affairs adopted a policy encouraging that POLST forms be made available to our nation’s veterans.

The Spokane VA provides care to veterans from Washington, Idaho, Montana, and sometimes Oregon. This website will allow you to access the form from your state, answer questions that you may have, and provide links to other materials. If you are a veteran at another VA hospital, be sure to ask your health care team for information about your state’s POLST form.

~ John Osborn, MD

physician, Spokane Veterans Medical Center

Do I need one of these forms?

How is this different from a Living Will?

-- answers to these and other commonly asked questions

can be found by clicking here.