By, Alicia Muir, Elder & Disability Law Clinic Student, Spring 2022
According to the American Medical Association (“AMA”), “[o]nly about one in three Americans has some type of advance directive on file with their health care providers.” One result of the COVID-19 pandemic is that many were reminded about the importance of planning ahead to communicate their medical care preferences. Generally, such documents are viewed as for the elderly; however, in the age of COVID, these legal documents can be valuable to a variety of individuals. One can create a living will, an advanced medical directive, and/or a health care power of attorney to ensure that their wishes are followed if they are unable to express their preferences concerning medical treatments themselves. The focus of this blog will be to evaluate a relatively new planning tool—POLST forms.
What is a POLST form?
A POLST form—physician’s order about life-sustaining treatment— an increasingly popular advance care planning tool. The purpose of such a form is to communicate to health care personnel, family, and friends the type of medical treatment an individual wants to receive if they have a serious medical illness. POLST forms allow one to document their preferences concerning CPR, surgery, respirators, feeding tubes, and artificial nutrition.
A POLST form provides medical treatment providers with a medical order. Without such a form, emergency responders like paramedics and EMTs are required to provide all possible medical treatments to sustain life. With a POLST form, a paramedic and EMT can follow your wishes relating to CPR, feeding tubes, and breathing machines. Hospitals follow the POLST orders as well; hospitals will ask patients whether or not they have a living will, health care power of attorney, or a POLST form in an attempt to conform medical treatment to the patient’s wishes.
A unique feature of POLST forms is that, unlike other advanced care planning documents, individuals often keep POLST forms readily accessible or on their person. In fact, POLSTs are also referred to as portable medical orders. For example, in some senior living facilities, residents carry the POLST form on their person or keep it on the refrigerator. By carrying it or placing it on a place of prominence, it would be accessible and viewable by emergency responders, family, or friends.
Obtaining POLST Forms in Virginia
To obtain a POLST form, you must contact your health care provider. Since the POLST form is a medical order, it needs to be provided and signed by a health care provider. Also, by requiring individuals to obtain the form through a health care provider, it ensures that everyone understands their options before making final decisions about various medical treatments.
POLST forms can vary from state to state. In Virginia, POLSTs are called POSTs – Physician Orders for Scope of Treatment. Click here to view a sample POST in Virginia. The Virginia POST is a program that followed the National POLST model. The Virginia program was designed in 2006 by the Palliative Care Partnership of the Roanoke Valley. The second pilot site was Sentara Leigh Hospital in Norfolk, Virginia; this pilot expanded to incorporate two skilled nursing facilities and emergency medical services in Norfolk and Virginia Beach. Since 2006, Virginia’s POST has expanded to 15 pilots across the state of Virginia including Eastern Virginia, Fredericksburg, Northern Virginia, Richmond, and Charlottesville. In November 2016, Virginia amended VA Code 12 VAC5-66-10 to include POST. The amendment included POST forms as a “durable DNR Order.” Thus, in Virginia the POST forms are officially recognized and carry legal weight.
Role of POLST Forms
While a helpful tool for advance care planning, POLST forms are not a replacement for legal documents detailing one’s preferences for advance care plans. Rather, after completing an advance directive, living will, and/or health care power of attorney, one could look to complete a POLST form as a means to communicate their personal choices to medical service providers quicker. While useful, a POLST form is not a necessity. Those without POLST forms are provided with all treatments until they are informed of the advanced care planning wishes. Thus, the POLST form is just another tool that can be of particular use for the elderly, frail, or terminally ill because their wishes can be quickly communicated. If you think you may benefit from a POLST form, reach out to your health care provider to learn more details.
 Marc Zarefsky, Doctors on COVID-19 Front Lines Eye Their Own Advance Directives, Am. Med. Ass’n (April 16, 2020), https://www.ama-assn.org/delivering-care/ethics/doctors-covid-19-front-lines-eye-their-own-advance-directives.
 See generally Danielle Christina Funk et al., How COVID-19 Changed Advance Care Planning: Insights from the West Virginia Center for End-of-Life Care, 60 J. Pain Symptom Mgmt. (2020), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506348/.
 Portable Medical Orders: What to Know Before Talking About POLST, POLST at 1, (June 2020), https://polst.org/wp-content/uploads/2020/06/2020.06.10-National-POLST-Patient-Guide-Before-Talking-About-POLST.pdf.
 Advance Directives for Virginia Residents, Hospice of Virginia, https://hospiceofvirginia.com/resources/advance-directives/ (last visited Feb. 20, 2022).