Advance Directive vs POLST: Understanding California's Healthcare Documents

Two different documents for two different situations

By Rozsa Gyene, Estate Planning Attorney | State Bar #208356

Quick Summary: Which Do You Need?

  • Healthy adults of any age: Advance Healthcare Directive only
  • Seriously ill or elderly: Both Advance Directive AND POLST
  • Young and healthy: Advance Healthcare Directive only (POLST not appropriate)

What is an Advance Healthcare Directive?

An Advance Healthcare Directive (sometimes called a "living will" or "healthcare proxy") is a legal document that does two important things:

  1. Names a healthcare agent: Someone who makes medical decisions for you if you can't speak for yourself
  2. States your wishes: Your preferences about life support, pain management, and end-of-life care

Key Features of Advance Healthcare Directive

What is a POLST?

POLST stands for "Physician Orders for Life-Sustaining Treatment." It's a bright pink medical order form that provides specific instructions to healthcare providers and emergency responders.

Key Features of POLST

Important: POLST is NOT for Healthy People

POLST is designed for people who are seriously ill, elderly, or have a life expectancy of less than one year. If you're healthy, a POLST is not appropriate for you - and doctors won't sign one. Stick with an Advance Healthcare Directive.

Side-by-Side Comparison

Feature Advance Directive POLST
Who creates it You (no doctor needed) You + your doctor
When it takes effect Future incapacity Immediately
Legal status Statement of wishes Medical order
Who should have it Everyone over 18 Seriously ill/elderly only
Names healthcare agent Yes No
Specific CPR instructions General guidance Yes - binding order
Recognized by EMTs Usually no (too long) Yes (designed for them)

What Does a POLST Cover?

The California POLST form addresses specific medical interventions:

Section A: Cardiopulmonary Resuscitation (CPR)

Section B: Medical Interventions

Section C: Artificially Administered Nutrition

Who Needs Which Document?

Healthy Adults (Any Age)

You need: Advance Healthcare Directive only

POLST is not appropriate for you. Create an Advance Healthcare Directive to name your healthcare agent and express your general wishes. Update it every few years or after major life changes.

Seriously Ill or Elderly

You need: Both Advance Healthcare Directive AND POLST

The Advance Directive names your healthcare agent and provides general guidance. The POLST provides specific, actionable medical orders that EMTs and hospitals will follow immediately.

How They Work Together

For someone who is seriously ill, both documents play important roles:

The POLST translates your Advance Directive wishes into specific medical orders that healthcare providers can follow immediately.

How to Get Each Document

Advance Healthcare Directive

POLST Form

Common Questions About POLST

Is a POLST the same as a DNR?

A DNR (Do Not Resuscitate) is one option within the POLST form. The POLST is more comprehensive - it covers CPR, ventilation, antibiotics, feeding tubes, and hospitalization preferences. You can choose full treatment, selective treatment, or comfort-only treatment.

Can I change my POLST?

Yes. You can revoke or change your POLST at any time by talking to your doctor. Your wishes may change as your condition changes.

What if my POLST conflicts with my Advance Directive?

The most recent document typically controls. However, it's best to keep them consistent. Update your Advance Directive if you create a POLST with different preferences.

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Frequently Asked Questions

What is an Advance Healthcare Directive?

An Advance Healthcare Directive is a legal document that lets you specify your medical wishes for future situations when you can't speak for yourself. It also names a healthcare agent to make decisions on your behalf. Every adult over 18 in California should have one.

What is a POLST form?

POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form signed by your doctor. It provides specific instructions for emergency responders and hospital staff about CPR, ventilators, and other life-sustaining treatments. It's typically for people with serious illness or limited life expectancy.

Do I need both an Advance Directive and POLST?

It depends on your health. Everyone should have an Advance Healthcare Directive. POLST is only appropriate for people who are seriously ill, elderly, or have a life expectancy of less than one year. If you're healthy, you only need the Advance Directive.

Is a POLST the same as a DNR?

A DNR (Do Not Resuscitate) is one section of the POLST form. The POLST is more comprehensive - it covers CPR, ventilation, antibiotics, feeding tubes, and hospitalization preferences. The POLST form allows you to choose "Full Treatment," "Selective Treatment," or "Comfort-Focused Treatment."

Does your living trust package include an Advance Healthcare Directive?

Yes. Our $400 living trust package includes a California-compliant Advance Healthcare Directive, along with your living trust, pour-over will, and financial power of attorney. It's everything you need for complete estate and healthcare planning.

Living Trust California | Attorney Rozsa Gyene | State Bar #208356

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