Does a POLST Need to Be Signed by a Physician?
While state laws vary, the answer is generally yes, a Physician Orders for Life-Sustaining Treatment (POLST) form almost always requires a signature from a physician, nurse practitioner, or physician assistant to be valid and actionable.
Understanding Physician Orders for Life-Sustaining Treatment (POLST)
POLST, sometimes referred to as MOLST (Medical Orders for Life-Sustaining Treatment) or COLST (Clinician Orders for Life-Sustaining Treatment) depending on the state, is a standardized medical order form designed to document a person’s wishes regarding life-sustaining treatment. It bridges the gap between advance directives (like living wills) and actionable medical orders, ensuring that a patient’s end-of-life preferences are honored in emergency situations and across various healthcare settings.
The Purpose and Benefits of a POLST Form
The POLST form’s primary goal is to improve the quality of end-of-life care by:
- Ensuring patient wishes are respected: It provides clear, actionable medical orders based on a patient’s informed decisions.
- Facilitating communication: It serves as a readily available document to communicate those wishes to healthcare providers.
- Reducing unwanted interventions: It helps prevent unwanted or unnecessary medical treatments.
- Minimizing conflict: It reduces the potential for disputes among family members and healthcare providers.
The POLST Completion Process
The POLST form completion process typically involves the following steps:
- Discussion: A healthcare professional, such as a physician, nurse practitioner, or physician assistant, discusses the patient’s medical condition, prognosis, and treatment options.
- Decision-Making: The patient (or their surrogate decision-maker, if the patient lacks capacity) makes informed decisions about their desired level of care.
- Documentation: The patient’s wishes are documented on the POLST form.
- Signature: A qualified healthcare professional (typically a physician), nurse practitioner, or physician assistant signs the form.
- Accessibility: The completed POLST form is readily accessible to healthcare providers. This may involve keeping a copy at home, in a medical record, or using a state registry.
Why a Healthcare Professional’s Signature Is Required
The requirement of a healthcare professional’s signature stems from the fact that a POLST form contains medical orders. These orders dictate specific medical interventions, such as the use of CPR, intubation, and artificial nutrition. Only licensed healthcare professionals with the authority to issue medical orders can legally and ethically sign a POLST form. This ensures the orders are medically appropriate and consistent with accepted standards of care. Does a POLST Need to Be Signed by a Physician? The answer is overwhelmingly yes, due to the inherent nature of the form as a medical order.
The Difference Between a POLST and an Advance Directive
While both POLST forms and advance directives address end-of-life care preferences, they serve different purposes:
| Feature | Advance Directive | POLST Form |
|---|---|---|
| Purpose | Expresses general preferences for future care | Documents specific medical orders for current treatment |
| Scope | Broad; applies to a range of future scenarios | Narrow; addresses specific medical interventions |
| Trigger | Becomes effective when the patient loses capacity | Effective immediately upon signing |
| Signature | Typically requires only the patient’s signature | Requires the signature of a physician, nurse practitioner, or physician assistant |
| Portability | May not be recognized across state lines | More portable and recognizable in different healthcare settings |
| Target Population | All adults | Individuals with serious illnesses or frailty |
Common Mistakes to Avoid When Completing a POLST
- Failing to have a thorough discussion with a healthcare professional.
- Not understanding the implications of each treatment option.
- Completing the form without the patient’s informed consent (or that of their surrogate).
- Failing to make the POLST form readily accessible to healthcare providers.
- Using an outdated version of the POLST form.
- Assuming an advance directive is sufficient to address immediate medical needs.
- Thinking the POLST is a substitute for a will or other legal document.
What Happens If a POLST Is Not Signed by a Qualified Healthcare Professional?
If a POLST form is not signed by a physician, nurse practitioner, or physician assistant (or another qualified healthcare professional according to state law), it is generally considered invalid and unenforceable. Healthcare providers are not obligated to follow orders contained in an unsigned POLST form.
Frequently Asked Questions About POLST Forms
Why is the physician’s signature so important on a POLST form?
The physician’s (or qualified healthcare professional’s) signature validates the medical orders contained within the POLST form. It confirms that the orders are medically appropriate and consistent with the patient’s wishes, following a thorough medical assessment and discussion. The signature also provides legal protection for healthcare providers who follow the orders in good faith.
Can a family member sign a POLST form on behalf of the patient?
No, a family member cannot sign a POLST form on behalf of the patient unless they are the patient’s legally authorized surrogate decision-maker, and even then, the form still requires the signature of a qualified healthcare professional. The family member’s role is to participate in the discussion and ensure that the patient’s wishes are accurately reflected on the form.
What if a patient doesn’t have a primary care physician?
If a patient does not have a primary care physician, they can consult with other healthcare professionals, such as a hospitalist, palliative care specialist, or nurse practitioner, to complete a POLST form. Many hospitals and healthcare systems have protocols in place to assist patients in completing these forms.
Is a POLST form the same as a Do Not Resuscitate (DNR) order?
While a DNR order can be included within a POLST form, the POLST form is more comprehensive. A DNR order specifically addresses CPR, while a POLST form can cover a wider range of life-sustaining treatments, such as intubation, mechanical ventilation, and artificial nutrition.
How long is a POLST form valid?
A POLST form remains valid unless it is revoked or revised by the patient (or their surrogate). It’s recommended to review the POLST form periodically, especially if there have been significant changes in the patient’s health status or wishes.
What happens if a patient changes their mind after signing a POLST form?
A patient has the right to change their mind at any time, as long as they have the capacity to do so. They can revoke or revise the POLST form by notifying their healthcare providers and completing a new form. It’s crucial to communicate these changes clearly and document them appropriately.
Do POLST forms transfer across state lines?
While efforts are underway to promote national standardization of POLST forms, the recognition of POLST forms across state lines can vary. It’s recommended to check with healthcare providers and legal experts in different states to ensure that the POLST form will be honored.
Where should I keep my POLST form?
The completed POLST form should be kept in a readily accessible location, such as at home in a visible place (e.g., on the refrigerator) or with the patient’s medical records. Some states have POLST registries that allow healthcare providers to access the form electronically.
What if there is a conflict between a POLST form and an advance directive?
In general, the POLST form takes precedence over an advance directive because it contains specific medical orders for current treatment. However, healthcare providers should make every effort to reconcile any conflicts and ensure that the patient’s wishes are honored to the greatest extent possible.
Are there any costs associated with completing a POLST form?
The costs associated with completing a POLST form can vary. Some healthcare providers may charge a fee for consultations or completing the form. However, many resources are available to help patients complete POLST forms at little or no cost.
What happens if a healthcare provider refuses to follow a POLST order?
Healthcare providers are generally obligated to follow valid POLST orders. However, there may be situations where they cannot do so, such as if the order is medically inappropriate or conflicts with their ethical obligations. In such cases, the provider should document their reasons for not following the order and work to find a resolution that respects the patient’s wishes.
Does Does a POLST Need to Be Signed by a Physician even when a person is under hospice care?
Yes, does a POLST need to be signed by a physician, even when a person is under hospice care. While hospice care focuses on comfort and symptom management, the POLST form clarifies specific medical interventions, such as CPR or hospitalization. The physician’s signature ensures that these orders are medically sound and aligned with the patient’s wishes within the hospice framework.