Advance Directives & POLST

Oregonians have the right to make health care decisions in advance and to appoint health care representatives. Every Oregonian should make their preferences about the end of life known to their families long before illness strikes and regardless of their age. They should ensure that their wishes are followed, if and when a crisis does occur, by completing advanced directives and by appointing a surrogate to make decisions on their behalf, when they are unable to do so themselves. Without advanced directives, the presumption is made that a person wants full treatment, even if that treatment may be futile. Preferences for hospice care and comfort measures can be indicated in advance directives, if a person becomes terminally ill. A lawyer is not needed to complete these documents.

Types of care that may be documented in an advance directive include request for artificial feeding, mechanical ventilators, CPR, antibiotics, dialysis and other invasive procedures.  Additional instructions  may include a preference for or against life-prolonging treatments if recovery of physical or mental health is not expected.  A person may also include what they would want under certain conditions; for example, if a person is suffering from dementia, if they are in a coma or have an advanced disease, they may request comfort measures or hospice care.

Portable Orders for Life Sustaining Treatment (POLST) Paradigm

The POLST Paradigm (Portable Orders for Life Sustaining Treatment) is an approach to end-of-life planning that focuses on advance care planning conversations between patients, health care professionals and loved ones; shared decision-making between a patient and his/her health care professional about the care the patient would like to receive at the end of his/her life; and ensuring patient wishes are honored.

Because it is a medical order, a POLST form must be completed and signed by a health care professional and cannot be filled out by a patient.  The POLST form assures patients that health care professionals will provide only the care that patients themselves wish to receive, and decreases the frequency of medical errors.  POLST is not for everyone; POLST is only for those individuals diagnosed with serious advanced illness.  Those Oregonians who are frail, elderly, or facing the end of life should complete a POLST form with their physician.