Portable Medical Order Sets (POLST®): Ethical and Legal Landscape
15 NAELA Journal 1 (Fall 2019)
16 Pages Posted: 1 Jul 2019 Last revised: 7 Mar 2020
Date Written: 2019
Anyone who has observed the dying of a loved one or who has thought about medical care in the final months of life may be concerned about end-of-life care. How can individuals ensure that their care fits their needs and preferences if they cannot express these because of dementia, confusion, or other frailties? Some worry that they will receive care that is painful and aggressive in the last stages of disease even though they would prefer comfort care only. By contrast, others worry that physicians will withhold therapeutic care because they assume that such care is unwanted by patients who are near death. Reassurance can come in the form of POLST. POLST has traditionally been an acronym for “physician orders for life-sustaining treatment,” but the National POLST Paradigm now defines it as “a portable medical order form.” A POLST form is a tool that can help actualize patients’ wishes for end-of-life care because it consists of a set of medical orders that are integrated into the patient’s medical record. The POLST concept, however, raises significant ethical and policy concerns. This article describes and assesses POLST. It analyzes POLST benefits and risks and the laws and regulations that govern this end-of-life decision-making tool.
Keywords: POLST, Portable Medical Order Sets, end-of-life, advance directive, patient autonomy
JEL Classification: K23
Suggested Citation: Suggested Citation