On September 11, at a HALO event in Minneapolis, I addressed concerns about Hospice. Unfortunately, we ran out of time to answer all the questions attendees asked. People who ask questions deserve answers. Furthermore, when one person asks a question, it is likely that others are interested in the answer as well.
The 10/24/25 HALO Voice Alert answered questions about Nutrition and Hydration. Today, I will tackle questions about POLST (Physician Orders for Life Sustaining Treatment), a healthcare advance directive used extensively throughout the United States. It has various names and acronyms, but they all can be hazardous to your life.
WARNING:
+ All POLST forms reduce complicated medical decisions to a “check the box” format and are slanted toward encouraging refusal of life-saving and life-preserving treatment and care, resulting in avoidable deaths.
+ Once signed by a designated healthcare professional, POLST medical orders can go into effect even when a patient is fully competent and able to communicate his or her own medical decisions.
+ A POLST can override the patient’s legal representative’s authority.
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Q. What if the care center refuses to admit a patient without a signed POLST form?
A. In short, find another care center that will protect your life or the life of your loved one.
If it is impossible to find another appropriate facility, meet with the administrator of the offending care center or hospice. Explain to him or her that federal law (The Patient Self-Determination Act of 1990) prohibits requiring anyone to sign a healthcare advance directive of any kind. You may also want to point out that the National POLST website (FAQs - POLST, 11/6/24) confirms that this law applies to POLST, stating:
Completion of a POLST form should never be mandatory. Just as patients are not required to complete an advance directive or a DNR order, they should not be required to complete a POLST form. Facilities may have policies requiring certain patients be offered the opportunity to have the conversation and complete one, but completion of a POLST form should always be voluntary.
Nevertheless, in the experience of HALO’s patient advocates, hospices and nursing homes sometimes do require patients to complete POLST forms before admission. As a last resort, you might wish to have an attorney send a letter to the administrator suggesting that a trip to court may be in his or her future.
Q. Do doctors or hospital personnel have authority to issue POLST orders for patients without their knowledge or consent?
A. No. That's the simple answer.
The complicated answer is that healthcare providers have no legitimate authority to sign POLST orders without patients’ knowledge or consent. As noted above, a POLST should always be voluntary. Nevertheless, state laws and the policies of healthcare facilities are not always consistent with federal law. Therefore, the patient or the patient’s legal representative must regularly check medical records for an unwanted POLST form. (A POLST is usually a brightly colored—neon pink, green, yellow, etc.—form that is easy to spot.) If one is found, demand its immediate removal.
HALO recommends refusing to fill out or sign a POLST form. Do not allow anyone to push you into it. When approached with a POLST form, it is your right to firmly state, “I have a Medical Power of Attorney for Health Care* which will go into effect if ever I need my agent to make decisions for me. Until such time, I want to discuss my condition and treatment options with my attending physician as needed. Please respect my wishes.”
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