POLST (Physician Orders for Life-Sustaining Treatment) forms and advance care directives serve different purposes, and while POLST forms aren’t inherently “bad,” they can create complications if you already have an advance care directive. Here’s why some people might view POLST forms as problematic in this context:

• Potential for Conflicting Instructions: An advance care directive outlines your general wishes for medical care, often naming a healthcare proxy to make decisions. A POLST form, however, translates specific medical preferences into actionable physician orders (e.g., DNR, comfort care). If the POLST form isn’t carefully aligned with your advance directive, it could contradict your broader wishes, leading to confusion in emergencies.
• Narrow Scope of POLST: POLST forms are designed for seriously ill or frail patients nearing the end of life, focusing on immediate, specific interventions (e.g., CPR, intubation). If you have an advance directive but aren’t in this critical stage, a POLST might oversimplify or misrepresent your preferences, locking you into decisions that don’t reflect your full directive.
• Risk of Misinterpretation: POLST forms are concise and meant for quick reference by medical personnel (e.g., EMTs). This brevity can lead to misinterpretation, especially if the form doesn’t fully capture the nuances of your advance directive. For example, a POLST might indicate “no aggressive measures,” but your directive might allow for certain treatments under specific conditions.
• Legal Precedence: In some states, POLST forms, as physician orders, may take precedence over an advance directive in emergency situations. If the POLST doesn’t accurately reflect your directive, it could override your broader wishes, especially if first responders or ER staff rely solely on the POLST.
• Redundancy and Complexity: If your advance directive is clear and comprehensive, a POLST might be redundant, adding unnecessary paperwork. Managing both documents can also lead to errors, like outdated POLST forms contradicting a recently updated directive.
• Limited Flexibility: POLST forms are meant to be followed as medical orders, leaving less room for situational judgment by healthcare providers or your proxy. An advance directive, by contrast, allows your proxy to adapt decisions to the context of your condition, which might be preferable for some.

When POLST Forms Might Still Be Useful

Despite these concerns, POLST forms can complement an advance directive if:

• You’re seriously ill or terminally ill, and you want clear, specific orders for emergency care.
• Your advance directive is vague, and you want to ensure certain preferences (e.g., DNR) are immediately actionable.
• You work closely with your healthcare provider to ensure the POLST aligns perfectly with your directive.

Recommendations

• Review Both Documents: Ensure your POLST (if you have one) and advance directive are consistent. Update them regularly, especially after health changes.
• Consult Your Doctor: A healthcare provider can help align the POLST with your directive and clarify when a POLST is necessary.
• Communicate Clearly: Inform your healthcare proxy, family, and medical team about both documents to avoid confusion.
• Check State Laws: Legal rules vary by state, so confirm how POLST and advance directives interact in your jurisdiction. For example, some states prioritize POLST in emergencies, while others give equal weight to both.