Momi and Roland are a retired couple living in Central O‘ahu. Last year Roland learned he has incurable lung cancer and has been in the hospital several times. The couple has had many conversations together and with the doctors. Because of his short life expectancy and desire for quality of life, he has decided to forgo aggressive life-prolonging treatments although he still wants hospitalization if needed. His doctor recommended that he put his wish to let nature take its course in writing in a document called POLST (Physicians Orders for Life-Sustaining Treatment). This form, signed by his doctor, will ensure that his healthcare wishes be carried out if he is not able to speak for himself at anytime. It also helps put Momi at ease, since she is the one who will be called on to make decisions for Roland if he is unable.

One night, Roland has problems breathing. Momi calls 911 and the paramedics arrive. Knowing her husband’s wishes, Momi wants to be sure that if her husband’s heart or breathing stop en route to the hospital, he can have the natural death he desires. She runs to the kitchen, grabs the completed and signed POLST form hanging on their refrigerator, and hands it to the paramedics. Momi can now feel a sense of relief that her husband’s treatment wishes will be followed, even if she’s not around to tell his medical providers.

So, what is a POLST, and how does it work? A POLST is a portable doctor’s order that makes you or your loved one’s wishes for treatment known. Portable means that it is valid wherever the patient is, whether it is at home, in an ambulance, in an emergency department or anywhere in the hospital or a nursing home. It is for people with a chronic debilitating illness or a life-limiting disease, such as end-stage lung or heart disease, a terminal cancer or anyone who may be approaching the end of their life.

How is the POLST different from an Advance Healthcare Directive (AD)? POLST is completed by you and your doctor and turns your healthcare wishes into orders for healthcare providers and ambulance personnel to follow. An AD is a form that you and everyone over 18 should have to document your values and future wishes for healthcare, and allows you to appoint an agent to act as your health care power of attorney in the event you are unable to speak for yourself. The combination of the POLST and AD will help make sure your wishes are known even if you cannot speak for yourself.

Be just as prepared as Momi and Roland! By talking about these issues ahead of time, you can prevent crisis, relieve stress and ensure that your family’s healthcare wishes are honored. Take action and start the conversations today. To learn more about the POLST and AD or to download forms, visit


Kokua Mau
Hawaii Hospice and Palliative Care Organization
808-585-997 |