A Living Will is an important document for every adult. But for retirees who are seriously ill, managing a significant chronic condition, or medically frail, a Living Will has a practical limitation that most people don't know about until it's too late. Emergency medical services — paramedics, EMTs — cannot read a Living Will. When they arrive at a scene, they are legally required to attempt resuscitation and provide life-sustaining treatment unless they have a specific type of medical order telling them not to. A Living Will, which is a legal document, does not qualify as that medical order.
POLST stands for Physician Orders for Life-Sustaining Treatment. In some states it is called MOLST (Medical Orders for Life-Sustaining Treatment) or a similar name. The terminology varies by state, but the function is the same. A POLST is a medical order — signed by both the patient (or their authorized representative) and a licensed clinician (a physician, nurse practitioner, or physician assistant) — that translates a patient's goals of care into actionable clinical instructions. Because it is a medical order rather than just a legal document, emergency medical personnel and all care providers are legally required to follow it. Unlike an Advance Directive (Healthcare Proxy or Living Will), which is intended for all adults, a POLST is specifically designed for people who are seriously ill, medically frail, or have a limited life expectancy — often defined as less than one year, though this varies by state. **Advance Directive vs. POLST: Different Tools for Different Situations** Aspect Advance Directive (Proxy POLST / MOLST** / Living Will)** Who needs it Every adult 18 and older Seriously ill, medically frail, or limited life expectancy What it is A legal document A current medical order expressing future — treated like a preferences prescription Who signs it The patient plus The patient or surrogate witnesses/notary AND a licensed clinician When it's used When the patient loses Immediately — in capacity (future planning) emergency situations, hospitals, nursing homes, home care Followed by EMS? No — EMS must treat Yes — EMS is legally unless POLST/DNR is required to honor it present Flexibility High — documents general Specific — section by wishes section clinical instructions Source: NCOA — What Is a POLST Directive; New York State Department of Health — MOLST FAQ; ACTEC — Advance Medical Directives
While the exact format varies by state, most POLST/MOLST forms are organized into specific sections that allow for nuanced instructions: **Whether to attempt cardiopulmonary resuscitation if the heart and breathing stop. This is the standard "Do Not Resuscitate" (DNR) instruction, but documented as a medical order rather than just a stated preference.** Section A — CPR Preferences: **Guidance for when the patient is alive but critically ill. Options typically range from full treatment (all medically appropriate interventions) to selective treatment (hospitalization if needed, but no intensive care) to comfort-focused care (focusing on relief of pain and symptoms rather than treatment of the underlying disease).** Section B — Medical Interventions: Whether to use antibiotics for life-threatening infections. Section C — Antibiotics: **Preferences regarding feeding tubes, including options for long-term tube feeding, a time-limited trial, or no artificial nutrition.** Section D — Artificial Nutrition: In New York State, the MOLST form is specifically designed to travel with the patient across all care settings — from hospital to nursing home to home care — so that the patient's preferences are not lost during transfers between facilities. The form becomes part of the medical record at each location.
The gap this fills is concrete. Consider a retiree with advanced heart failure who has clearly documented in their Living Will that they do not want aggressive resuscitation if their condition becomes terminal. They collapse at home. Family members call 911. Paramedics arrive. They see the Living Will. Under most state laws, they cannot honor it — it is a legal document, not a medical order. They are required to initiate CPR and transport to the hospital. If that same retiree had a POLST signed by their physician with a DNR instruction in Section A, the paramedics would be legally required to follow it. The POLST is the medical order; the Living Will is not. This is not a technicality. It is the difference between a patient receiving the care they wanted and receiving interventions they explicitly chose to avoid — at the most vulnerable moment of their life.
A POLST is not something you create by yourself. It requires a conversation with your primary care physician or a specialist, followed by joint completion and signing of the form. The conversation should cover your current health status, your goals of care, your understanding of the likely course of your illness, and your preferences regarding specific interventions. Most states have standardized POLST forms available through the state health department or relevant medical organizations. The completed form should be kept accessible — not in a safe deposit box, not in a filing cabinet in a back room. It should be on the refrigerator, in the bedside table, or in any location where emergency personnel or home health aides can find it quickly. A copy should be given to any facility where the patient receives regular care: a cardiologist's office, a dialysis center, a skilled nursing facility. The form should also be updated whenever the patient's health status or preferences change.
A primary care physician or palliative care specialist can discuss
NCOA — What Is a POLST Directive; New York State Department of