MSD Manual

Please confirm that you are not located inside the Russian Federation

honeypot link
Differences Between Advance Directives and POLST

Differences Between Advance Directives and POLST


Advance Directives



All adults, regardless of current health

A person of any age with a serious illness or frailty when the health care professional would not be surprised if the patient died within the next year or two

Who writes it

The person, with or without an attorney

A doctor or, in some states, a nurse practitioner or physician assistant after care planning has been discussed with the person (or parent, guardian, conservator, agent, or other surrogate decision maker)

Where completed

Any setting

Medical settings

What it communicates

Preferences (not medical orders) regarding possible future treatment alternatives and appointment of a substitute medical decision maker (health care agent)

A doctor's medical orders for major critical care decisions that could arise because of the patient's current medical condition

Decisions by surrogates (substitute decision makers)

Surrogates cannot make an advance directive for the patient

Surrogates can participate in and consent to POLST when patients lack the capacity to make their own decisions

Emergency medical care

Generally does not apply to emergency care

Applies to emergency care

Responsible for providing the documents to health care professionals wherever care is provided

Patient's and family's responsibility

Health care professional's responsibility

Who reviews and revises the document as needed

The person who made the advance directive

The health care professional with the person or surrogate

Use of both documents for the same person

Specifies general goals and wishes through all stages of the person's life and serves as a starting point for discussing POLST

Complements advance directives by converting the person's general goals and wishes into specific medical orders

POLST = Provider Orders for Life-Sustaining Treatment.