If you were to collapse unexpectedly, how aggressively would you want emergency medical personnel to act in trying to keep you alive? If you were a typical, healthy, individual, you would probably say, “do whatever it takes to keep me going, even if you have break a few ribs to do it!” (This can happen during CPR — cardiopulmonary resuscitation.) However, if you were in the end stage of a terminal disease, such as a cancer that had spread throughout your body, and you knew your death were imminent, you may say, “keep me comfortable, but if my heart should stop, please let me go. Don’t try to resuscitate me.” That is where a Provider Order regarding Life-Sustaining Treatment (POLST) comes in.
A POLST is a special document that you and your doctor (or nurse practitioner) discuss, fill out, and sign to state your wishes about the measures that should be taken to keep you alive. It is different from an Advance Directive in that emergency personnel will follow it, provided that they are aware of its existence. Emergency medical technicians (EMTs) are required to do whatever they can do to restore and stabilize your heartbeat and breathing and take you to an appropriate facility for treatment. They will not take the time to read your Advance Directive and try to figure out how it might apply to your situation. But you can see how in some cases, resuscitation procedures may not be appropriate or wanted. A POLST, being a medical provider’s order, will be followed by the EMTs. Your Advance Directive will not come into play until you are in the hospital, and at that point, the EMTs may not have done you any favors by keeping your heart beating.
Almost all 50 states have some version of the POLST, but some call it by other names. In New York, it is called MOLST, and in West Virginia, it is MOST. VA medical centers have their own term, SAPO, which stands for State Authorized Portable Order. Whatever the alphabet soup used to name the document, all of the orders generally work the same way.
In Hawai‘i, if you have a POLST, we recommend that you print it on lime green paper so it will be recognizable immediately. The trick is to have your POLST nearby and in a conspicuous place in case you should need it. EMTs are trained to look for the green form and follow the POLST order. You can post a copy near your bed, and you can carry it with you when you leave the house. Just make sure your loved ones know where to find it if an emergency occurs.
Note that the POLST does not have to say “don’t resuscitate me.” It can say the exact opposite if that is your wish. Either way, most people do not need a POLST. However, for someone whose death is imminent and who doesn’t want to risk being kept alive artificially against his or her wishes, a POLST is essential.
SCOTT MAKUAKANE, COUNSELOR AT LAW Focusing exclusively on estate planning and trust law. Watch Scott’s TV show, Malama Kupuna Sundays at 8:30 pm on KWHE, Oceanic channel 11
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