Merck Manual

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Differences Between Advance Directives and POLST

Differences Between Advance Directives and POLST

Characteristic

Advance Directives

POLST

Eligibility

All adults, regardless of current health

Recognized in every state

Any adult (or parent for a minor child) with a serious illness or frailty when the health care practitioner would not be surprised if the patient died within the next year

POLST programs not available in every state

Who writes it

The person, with or without an attorney

A doctor or, in some states, a nurse practitioner or physician assistant after care planning has been discussed with the person (or, if the person is incapacitated, with the surrogate decision maker)

Where completed

Any setting

Medical settings

What it communicates

Preferences regarding possible future treatment alternatives (not medical orders) and appointment of a substitute medical decision maker (health care agent)

A doctor's medical orders for major critical care decisions that could arise because of the patient's current medical condition

Decisions by surrogates (substitute decision makers)

Surrogates cannot make an advance directive for the patient

Surrogates can participate in and consent to POLST when patients lack the capacity to make their own decisions

Emergency medical care

Generally does not apply to emergency care

Applies to emergency care

Responsible for providing the documents to health care practitioners wherever care is provided

Patient's and family's responsibility

Health care practitioner's responsibility

Who reviews and revises the document as needed

The person who made the advance directive

The health care practitioner

Use of both documents for the same person

Specifies general goals and wishes through all stages of the person's life and serves as a starting point for discussing POLST

Complements advance directives by converting the person's general goals and wishes into specific medical orders

POLST = Physician Orders for Life-Sustaining Treatment.