MSU Extension Office: Provider Orders for Life Sustaining Treatment

This is a series of articles focusing on estate and legacy planning. Authors are Kaleena Miller, MSU Extension Madison-Jefferson County Agent, kaleena.miller1@montana.edu, and Marsha Goetting, MSU Extension Family Economics Specialist, marsha.goetting@montana.edu.

If you have been in the hospital during the past few years, you know about a POLST. If not, you may ask, what is POLST? POLST is short for Provider Orders for Life-Sustaining Treatment. It is a medical order indicating treatment preferences for a person who has a life-threatening illness. The patient and a Montana licensed physician, advanced practice registered nurse, or physician assistant are the ones who sign the document.

A completed POLST establishes that you and your medical provider have discussed, and have specified treatment preferences when you have a serious illness. You do not have to fill out a POLST document. The completion of a POLST is VOLUNTARY.

The development of POLST in Montana was in response to seriously ill patients who received medical treatments not consistent with their wishes. The Montana Board of Medical Examiners was approached about creating a POLST document for the state. With help from the Montana Department of Public Health and Human Services (DPHHS), POLST first became available in Montana in 2010. Since that time, the document has been revised twice, most recently in September of 2019. If you completed a POLST form before September 2019, you do not need to fill out a new one. Earlier versions of the POLST forms are still valid until they are replaced by an updated version. The most recent form is an 8.5 x 11-inch double-sided paper (terra green) dated September 2019.

If you have not appointed a health care representative in some type of legal document [POLST form, health care power of attorney, advance care directive, declaration (living will)], Montana law provides authority to consent or to withhold consent for the administration of life-sustaining treatment may be exercised by the following individuals (in order of priority):

1. The spouse of the individual.

2. An adult child of the individual or, if there is more than one adult child, a majority of the adult children who are reasonably available for consultation.

3. The parents of the individual.

4. An adult sibling of the individual or, if there is more than one adult sibling, a majority of the adult siblings are reasonably available for consultation.

5. The nearest other adult relative of the individual by blood or adoption who is reasonably available for consultation.

Each state has its own POLST requirements and reciprocity rules for forms. If you are going to stay in another state for an extended period, your Montana POLST may need to be redocumented on that state’s form.

The Comfort One program has been eliminated from the Emergency Medical Services system in Montana. Comfort One has been replaced by POLST. Existing Comfort One documents and bracelets, however, will be honored by Emergency Medical Technicians (EMTs). A do-not-resuscitate (DNR) is a directive from a licensed physician or advanced practice registered nurse showing health care providers should not attempt cardiopulmonary resuscitation (CPR) if a patient’s heart or breathing stops. The state of Montana has replaced DNRs with a POLST.

Family members or friends who are faced with decisions about health care for a loved one should ask about the location of not only the original POLST, but also any other health care documents the person has completed [advance directive, health care power of attorney, or declaration (living will)].

More information about POLST is in the MSU Extension Montguide, Providers Orders for Life Sustaining Treatment (MT21112). The fact sheet is available at the MSU Extension Madison-Jefferson County Office. Call 406-287-3282 or download it at https://www.montana.edu/estateplanning/eppublications.html. Scroll down to #35.