MCLE ARTICLE: THE EVOLUTION AND USE OF THE POLST—PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT—IN CALIFORNIA

By Carolyn West, Esq.* and Philip D. Batchelder, Esq.**

With the enactment of Assembly Bill No. 3000 in 2008, California residents and their doctors began to implement the Physician Orders for Life-Sustaining Treatment (POLST)—a model form containing instructions for medical treatments and interventions. The POLST is an adjunct to the advance health care directive and is particularly useful for patients who are frail or elderly, or who have a terminal illness. A person is a good candidate for a POLST if it would not be surprising for him or her to die in the next year. The bright-pink POLST form contains medical orders indicating the specific types of life-sustaining treatment that the individual wants—and does not want—and accompanies the individual as he or she travels between care settings and stages of care.

This article reviews the POLST model as it was developed in California, explains its purpose and legislative history, and describes the context in which POLST operates, including other relevant laws and decisionmaking mechanisms. The article then outlines the often complex circumstances in which a POLST may be relevant and useful, and offers practical tips for an estate planning lawyer wanting to help those clients who are candidates to establish a POLST form to engage in effective advance care planning.

In this article, "POLST" refers to the POLST program or form, "advance health care directive" will be shortened to "advance directive," and do-not-resuscitate will be abbreviated "DNR."