You may have seen it happen, or perhaps heard about it afterward.

One early January evening in 2023, a Buffalo Bills football player named Damar Hamlin suddenly dropped to the ground during a game. Thanks to freak timing on a hard tackle, his heart had stopped. Hamlin easily could have died—but the medical crew stationed on the sidelines immediately performed lifesaving cardiopulmonary resuscitation (CPR).

“This is exactly the type of situation that CPR is made for,” explained Kathleen Cameron, Senior Director of NCOA’s Center for Healthy Aging. “Damar Hamlin is otherwise healthy and in good physical shape. There was no question about what to do."

“That said,” she continued, “it’s important to know that CPR is a traumatic procedure. Popular culture doesn’t usually talk about it this way, but CPR often can do more harm than good—especially for certain people who already are near the end of life.”

That’s where a POLST comes in.

What is a Provider Orders for Life-Sustaining Treatment, or POLST?

Short for “Provider Orders for Life-Sustaining Treatment,” a POLST is a type of advance directive that helps communicate your wishes for medical treatment when you can’t speak for yourself—for example, if your heart stops. But it doesn’t cover every situation. And not everyone should have one.

Curious about how a POLST works and whether it’s right for you or someone you know? We explain it all here.

What is the purpose of a POLST?

A POLST is a portable medical order written and signed by a doctor on your behalf. Depending on the state you live in, it might be called something else. These names are interchangeable and can include:

• MOLST – Medical Orders for Life-Sustaining Treatment
• COLST – Clinician Orders for Life-Sustaining Treatment
• POST – Provider Orders for Scope of Treatment
• MOST – Medical Orders for Scope of Treatment

“Portable” means that a POLST goes where you go. And “medical order” means that it’s a binding document. Any health care provider with knowledge of your POLST must follow the instructions that you (or your healthcare proxy) agreed to and wrote down together with your physician. This is true whether your care happens in a hospital, in a nursing facility, in the back of an ambulance, or even in your own home.

The purpose of the POLST is to give you control over the types of care you do and do not want during a life-threatening medical emergency. It answers such questions as:

• Do you want CPR performed if your heart stops?
• Do you want to go to the hospital if you’re not already there? Or stay where you are?
• Do you want to be put on a machine if you can’t breathe on your own?
• Do you want a feeding tube if you can’t chew or swallow?
• Do you want antibiotics if you have an infection?
• Do you want aggressive treatments at all costs?
• Do you want comfort care only?

“Think of a POLST this way: it’s a mirror that reflects your highly personal goals and definition of ‘quality of life,’” NCOA's Cameron said. “If you already are near the end of your natural life, do you want to stay alive as long as possible no matter what—or would you prefer to forego heroic measures? Maybe your child is getting married and you want to live to attend the wedding. Or maybe you don’t want to endure additional pain. No matter how you answer, your POLST tells your medical providers exactly how to care for you in a crisis in a way that upholds your values.”

Do I need a POLST?

If you’re generally healthy, no: you do not need a POLST.

Why? Because a POLST is very specifically intended for people who have a life-limiting illness, advanced frailty, or both.

A life-limiting illness is one you’re not likely to recover from, including (but not limited to):

• Certain cancers
• Progressive dementia (like Alzheimer’s)
• End-stage kidney disease
• Lou Gehrig’s disease (ALS)
• Other terminal conditions

Advanced frailty describes significant physical deterioration resulting from serious illness. It also can be a function of age—though not every older person becomes frail. No matter the cause, frailty leaves you highly vulnerable to poor health outcomes, especially when aggressive treatment may be necessary. (For example, if you’re frail and need CPR, chances are high that you will suffer broken ribs, injured organs, or worse).

A POLST describes the treatments you do and don’t want given your current state of health. It directs any immediate treatments you might need during an emergency. This makes it different from a living will, which communicates the care you prefer in the future. (See the below FAQ on living wills for more detail).

How do I create a POLST?

First and foremost, you need to have an honest conversation with your doctor about your medical condition, your prognosis, and your treatment wishes. (You may want to include your family, your health care proxy, or other people involved in your care).

During this discussion, you doctor will walk you through the POLST form and explain any medical terms and treatments so that you fully understand what they are and how they relate to your specific situation.

Then, you will complete the form together. Your POLST only becomes valid once you and your physician sign it.

While POLST forms may differ slightly by state, each version includes the same four basic sections:

• Section A: Cardiopulmonary resuscitation (CPR). This covers what you want medical providers to do if your heart stops.
• Section B: Medical interventions. This covers what you want medical providers to do if your heart is still beating, but you are critically ill. Here, you indicate preferences about where to receive care if you want it, and what types of care you do and do not choose.
• Section C: Antibiotics. This covers what you want medical providers to do if you develop a life-threatening infection. It’s an important piece of your POLST because some antibiotics have serious side effects and require hospitalization to administer.
• Section D: Artificial nutrition. This covers what you want medical providers to do if you can’t eat or drink on your own.

National POLST provides a helpful video that clearly explains each part of the form and how to complete it. It may be helpful for your decision-making process to watch it with your caregivers before completing your POLST, but it’s not necessary to do so.

If you would like to review a blank copy of the POLST before completing it with your doctor, you can find your state form online. 

What should I do with my POLST once I have one?

Make copies of the form and share them with your medical providers and caregivers. If you live at home, keep a copy in a visible location, such as on your refrigerator.

The bottom line

A POLST is not for healthy people. This form of advanced directive is specifically intended for people who are terminally ill or medically frail and is one important piece of the overall process of preparing for end of life. If you or someone you know lives with advanced disease or frailty, a POLST empowers you to control the type of care you receive, and where you receive it, if you experience a life-threatening medical emergency. Talk to your health care provider about whether you should have a POLST and how to create one. If you decide to move forward, your provider will help you complete the form. Once you both sign it, your POLST becomes a binding portable medical order that tells EMTs, nurses, physicians, and other trained medical professionals how to treat you when you can’t communicate those wishes yourself.

Additional FAQ

Is a POLST different from an advance directive?

Yes and no. A POLST is actually a type of advance directive, which is an umbrella term used to describe several different legal documents, including:

• Living wills
• Medical powers of attorney (health care proxy / health care surrogate)
• Do Not Resuscitate (DNR) orders

Ideally, these directives make up your comprehensive plan for end of life care. They work together to clearly communicate your wishes so that your medical team, family members, and caregivers can honor them.

Every adult should have a living will and health care proxy. As discussed above, a POLST is only necessary for people with limited life expectancy.

POLST vs DNR: What is the difference?

A POLST is more comprehensive than a “Do Not Resuscitate” order.

A DNR is a stand-alone document that tells emergency medical personnel whether to perform CPR if your heart and breathing stop and you are unresponsive.

A POLST includes your instructions about whether or not to perform CPR, but it doesn’t stop there. It also explains the types of end-of-life care you do and don’t want if you have a pulse and are breathing but are unable to communicate.

POLST vs living will: What’s the difference?

It might be easiest to think of a POLST as a medical order and a living will as a legal document. There are overlaps, but each directive is used differently and by different people.

A POLST directs your immediate care during a medical emergency. It tells EMTs, doctors, and other health care professionals what to do, and they are legally required to comply. Only seriously ill people with limited life expectancy should have a POLST.

A living will guides your future, non-emergency care. It helps your medical team, family, and health care proxy understand your wishes. However, a living will is not a medical order; if it specifies your preferences for CPR, for example, those preferences are not binding. Every person age 18 and older should have a living will, regardless of their health.

Is a POLST legally binding?

Yes. A POLST is a medical order. This means that doctors, nurses, EMTs, and other care providers will follow it. In most states, there are serious legal consequences for willfully ignoring a POLST. To learn what they are, contact your state POLST program.

Do I have to have a POLST?

No. You can always choose whether or not you want to create one. No one else can require you to go through the process and fill out the form. This is true even if you enter a care facility and they include POLST form in their admission papers or ask you to complete one later. It is always up to you.

Can I change my POLST?

Yes, at any time. Consult with your health care provider about how to change or void (cancel) your POLST; the process can differ depending on where you live.