When it comes to planning for future medical care, two documents often create confusion: the Advance Health Care Directive (AHCD) and the POLST (Physician Orders for Life-Sustaining Treatment). While both are important, they serve different purposes. Understanding how they work individually – and together – can help ensure your wishes are honored, both in the long term and during emergencies.
An AHCD is a legal document that allows you to plan ahead. It lets you:
- Appoint someone you trust (a health care agent or proxy) to make decisions if you cannot.
- Express your general values, wishes and instructions about medical care, life support and end-of-life preferences.
- Provide guidance on organ donation, pain management and overall quality-of-life goals.
Because the AHCD focuses on the future, it is useful for every adult, whether healthy, facing illness or planning ahead. However, in emergencies, the AHCD alone is often not enough. Paramedics and emergency staff typically cannot, in an emergency, stop to interpret a legal document in the moment. That is where the POLST comes in.
The POLST is a bright pink medical order, completed with your doctor, nurse practitioner or physician assistant. Unlike an AHCD, it is not a legal planning document; it is a medical order that must be followed immediately.
POLST is intended for people who are seriously ill, medically frail or nearing the end of life. It translates your treatment preferences into clear instructions about:
- Whether or not to attempt CPR (resuscitation).
- Use of ventilators, intubation and other hospital-based treatments.
- Use of artificial nutrition, such as feeding tubes.
- Comfort-focused care versus full treatment measures.
Because it is a doctor’s order, the POLST tells emergency responders exactly what to do in the moment. For example, if someone does not want resuscitation and has a POLST form stating “Do Not Resuscitate,” EMS is legally bound to honor it.
In California, both documents serve important but different roles: The AHCD is broad and long-term; it names a decision-maker and outlines your overall philosophy of care. The POLST is specific and immediate; it provides enforceable medical orders for emergencies.
If both documents exist, the POLST usually takes precedence in an emergency. However, the AHCD remains essential because it appoints an agent who can interpret your wishes in situations not covered by the POLST.
By having both, you cover all bases. Emergency personnel know what to do immediately and your health care agent can guide care in the bigger picture.
The POLST and the AHCD are not competing documents; they complement each other. Every adult should have an AHCD. A POLST, however, is best suited for people with serious illness or advanced age who want their current treatment wishes translated into medical orders. Together, these documents ensure that your voice is heard, both in the moment of crisis and in the broader journey of care.
Send your questions to ccolan@colanlegal.com and use “Alpine Mountaineer estate planning question” as the subject. We’ll answer your questions in our upcoming issues. This article is provided by your local estate planning attorney, Corina Colan. The Law Office of Corina I. Colan / (909) 265-3315 / www.colanlegal.com
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