Your Future Self Will Thank You: POLST and Healthcare Directives Now
Don't wait for a crisis to decide who speaks for you and what you want.
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Last month, a report from the National Academies of Sciences, Engineering, and Medicine detailed how roughly 20% of older adults in the U.S. Experience financial exploitation, losing an average of $1,000 each, often to phone scams targeting their confusion about Medicare benefits [c1]. It’s a stark reminder that vulnerability can strike suddenly, and often when we least expect it. I saw that report while waiting for my mom’s physical therapy appointment, the kind where you find yourself staring at the chipped linoleum and mentally running through the same old checklist: did I confirm the pharmacy refill? Did I remember to ask about that new medication side effect? My own complaint isn't that these reports exist – they’re necessary warnings. It’s how they’re often framed: as isolated incidents of 'seniors being tricked,' which implies a passive victim. The National Academies’ official stance is that these schemes 'exploit trust and psychological manipulation,' which is accurate, but it doesn't fully capture the active role people play in trying to protect themselves or their family. The standard advice, 'just be careful,' feels hollow when you’re dealing with a sophisticated con artist who has weeks to build rapport. What’s missing is a proactive, systemic approach. The real move, the one that bypasses the need for perfect vigilance, is to have a clear, legally documented plan in place for medical decisions. This isn't about avoiding scams; it's about ensuring your wishes are honored, no matter the circumstances. This week, take five minutes to find out what a POLST form is and where to get one in your state. It’s a concrete step that gives you control.
The direct answer
A POLST (Physician Orders for Life-Sustaining Treatment) form documents your current wishes for life-sustaining treatment, signed by you and your doctor. A healthcare directive (also known as a living will or advance directive) is a broader document outlining your preferences for medical care and designating someone to make decisions if you cannot. You need both right now because they ensure your voice is heard and your values are respected if you become unable to communicate them yourself.
POLST vs. Healthcare Directive: What's the Difference?
Think of a POLST form as a doctor's order sheet for your current medical situation, specifically addressing life-sustaining treatments. It’s designed for people with serious illnesses or advanced chronic conditions, and it needs to be signed by a physician or authorized healthcare professional. This document speaks directly to emergency responders and medical teams, telling them what treatments you do or do not want, such as CPR, mechanical ventilation, or artificial nutrition. It's about translating your values into actionable medical orders.
A healthcare directive, on the other hand, is a more general document that covers a wider range of your wishes. It typically includes two parts: a living will, which details your preferences for medical treatments in specific situations (like end-of-life care), and a durable power of attorney for healthcare (also called a healthcare proxy or medical agent), which names a person you trust to make decisions on your behalf if you are incapacitated. While a POLST is focused on immediate, life-sustaining interventions, a healthcare directive provides a broader framework and appoints your decision-maker.
While they serve distinct purposes, they are complementary. A POLST is crucial for immediate medical interventions, especially in emergency settings, and is often completed when someone has a serious health condition. A healthcare directive is essential for everyone, regardless of current health, to ensure ongoing preferences are understood and to appoint a trusted agent for all medical decisions when you cannot speak for yourself. Completing both provides a robust plan for your future care.
Why 'Later' Is the Worst Time for These Documents
It’s easy to think, 'I’m healthy now, I’ll get to this when I’m older' or 'when I get sick.' But life rarely waits for your paperwork to be in order. A sudden accident, a stroke, or a rapid decline from an illness can leave you unable to express your wishes. In those moments, without a POLST or healthcare directive, your family may be left guessing, facing agonizing decisions under immense emotional pressure.
Furthermore, these documents are not just for the very end of life. They can come into play if you experience a severe injury or illness that leaves you temporarily or permanently unable to communicate. Imagine being in a coma after a car accident; your healthcare directive ensures the person you trust can make decisions that align with your values, preventing unwanted interventions or treatments.
The process of creating these documents also serves a vital purpose: it forces you to confront your own values and priorities regarding life, death, and quality of life. This self-reflection can be incredibly clarifying and can lead to important conversations with your family, ensuring everyone is on the same page long before a crisis hits.
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Understanding the Nuances of Your Choices
A POLST form, for example, offers specific choices regarding cardiopulmonary resuscitation (CPR), artificial ventilation, and artificial nutrition. You can choose to receive or refuse these interventions. For instance, refusing mechanical ventilation doesn't mean you don't want any medical support; it means you don't want breathing assistance if your lungs are failing. It’s about specifying the *kind* of support you want, not necessarily *all* support.
Your healthcare directive allows you to express preferences about pain management, comfort care, and even organ donation. It can also outline your wishes regarding artificial hydration and feeding tubes. These are deeply personal decisions, and having them documented ensures that your personal definition of quality of life is prioritized.
Crucially, these documents are not set in stone. You can change them if your circumstances or wishes evolve. The important thing is to have them in place and to communicate your decisions to your designated agent and your family. Regular reviews, perhaps every few years or after a significant health event, are advisable to ensure they still reflect your current thinking.
Common mistakes
- Assuming your family knows your wishes
Even with close relationships, unspoken desires about medical care can lead to conflict and distress during a crisis. Your family may have different interpretations or be swayed by external pressures. Clearly documented wishes leave no room for ambiguity. - Waiting for a 'perfect' time to complete documents
The 'perfect' time never arrives. A sudden health event can leave you without the capacity to make these critical decisions, forcing your family to make them without your input. Procrastination can lead to care that doesn't align with your values.
Frequently asked
Where can I get a POLST form?
POLST forms are state-specific. You can usually obtain one from your doctor's office, hospital, or your state's Department of Health website. Some states also allow completion through designated non-profit organizations. It must be signed by a physician or authorized healthcare professional to be valid.
How do I choose someone to be my healthcare agent?
Select someone you trust implicitly, who understands your values, and who you believe will advocate for your wishes even when it's difficult. They should be capable of making tough decisions and communicating effectively with medical teams. It’s wise to discuss your wishes thoroughly with them beforehand.
Do these documents need to be notarized?
Requirements vary by state. While many healthcare directives do not legally require notarization, having them notarized or witnessed by individuals not named in the document can add an extra layer of legal validity and deter challenges. Check your state's specific laws for POLST and healthcare directive requirements.
Sources
- National Academies of Sciences, Engineering, and Medicine — Report on financial exploitation and abuse of older adults.
- National Institute on Aging — Information on advance directives, including living wills and healthcare powers of attorney.
- Compassion & Choices — Explanation of POLST forms and their purpose in life-sustaining treatment decisions.
- American Medical Association — Guide to the AMA POLST Program, detailing its role in physician orders for life-sustaining treatment.
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