P.O.L.S.T. stands for “Physician's Orders for Life-Sustaining Treatment”.  It is a legal document signed by a patient's physician that provides treatment-orders, usually in the context of terminal illness or other circumstances when a patient does not wish certain (or any) life-sustaining treatments to be initiated.  In the states where POLST legislation has been enacted, it is generally regarded as a binding legal document that must be followed by emergency medical technicians (paramedics) and other non-physicians, such as ambulance attendants, who could be in a position to initiate CPR.  Physicians retain the option of examining the patient and determining whether the POLST instructions conform to the accepted standard of medical care and/or do not violate the conscience of the treating physician.

CONTROVERSY in the Roman Catholic community concerning POLST reflects fear that it could be misused, either by patients who do not have a terminal illness, or by others on behalf of patients who are unaware that such a document has been executed.  This is of particular concern in states such as Minnesota and Wisconsin where the signature of the patient or their representative is optional — not mandatory — for validity.  In some states, such as Montana, the wording on the POLST form is unclear on this point.  In California a POLST is not valid unless signed by the patient or their designated surrogate.

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