Sixteen states around the country have implemented a new model of advance directives – the Physician Orders for Life Sustaining Treatment (POLST) paradigm – while 27 more states are considering doing the same.  (View a map here.)  POLST provides health care providers with more concrete guidance when determining whether to provide medical interventions to critically ill patients.  Current advance directives are generally documents executed by the patient, while in the POLST model, the physician sets out the patient’s wishes for end-of-life care in a written medical order with greater specificity regarding treatment options.  Because of the physician involvement, it is likely that POLSTs will be created for more patients than currently achieved with advance directives.

Each state may implement a different POLST form to accomplish these goals.  Many are modeled after the POLST form implemented in Oregon, a leader in the development of POLST.

Legal changes necessary to implement POLST may vary from state to state.  Implementation could come in the form of new state statutes specifically authorizing POLST, new state regulations, or, as suggested by advocates in Florida, obtaining feedback from relevant state agencies as to whether or not existing state statutes or state constitutions already allow physicians to implement POLST forms.