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POLST (Portable Orders for Life-Sustaining Treatment)
What is a POLST?
It is a medical form that turns your wishes for treatment near the end of life into medical orders. Emergency medical personnel will know what treatments you do and do not want performed during a medical emergency and will be required to follow the orders in the POLST. In the absence of a POLST, EMTs are required by law to administer CPR.
This form can be obtained from your chosen health care provider. With them, you can discuss your wishes and they will file the form with the State of Oregon. This will provide all Oregon emergency personnel with your specific wishes.
Issues that may arise when requesting POLST from your provider:
When requesting POLST forms, there may be difficulties related to “who should get a POLST ” There is no really correct answer, but each individual must decide based on their own informed wishes. To make an “informed choice,” examine the significance of the POLST form in our present time. Understanding it will make it easier for you to discuss the use of it with your provider.
POLST in Oregon is tied to a medical registry system that communicates the patient’s preference to the “emergency responders,”only. Unless it is known that the patient does not prefer to be resuscitated, EMTs are instructed to proceed with cardiac compression, initiate defibrillation, and proceed with intubation and mechanical ventilation.
The reported success rate of “out of hospital” CPR summarized in multiple studies, is only 7.6%. The potential neurologic damage following CPR , coupled with the low success rate of CPR in those over 65 has prompted many to consider rejecting resuscitation. If you indicate on the POLST you do not wish CPR, the EMTs will know that as they will check with the registry on their way to assisting you.
The latest versions of the Oregon POLST include a statement that it is for “frail or significantly ill.” The definition of “frail” is not clearly defined, complicating the decision of when a POLST should be completed. “ Regardless of your medical status, if you know you would not want to be resuscitated if you were found unresponsive, meaning that your brain would not be receiving oxygen, you should have a POLST.
POLST Information slide show - OHSU Center of Ethics, 6/10/2025
This is a slide show presented in June 2025 by Donna Routh of the Center of Ethics at OHSU. The Mortality & Choices Committee has concerns that materials provided by the OHSU Center of Ethics suggests that POLST should only be used by the “very ill and frail;” this may prompt individuals to delay considering whether or not they would desire CPR. We believe that anyone who would not want CPR performed on them if they were to be found unresponsive, regardless of their current state of health, should have a POLST.
Outcome of CPR in Individuals Over 65 - 2023 NPR Article
In some of the resource documents we are providing you will see language reflecting the “ill and frail” criteria. We are including these documents because they contain other, valuable, information. The M&C committee has provided additional information about the outcome of CPR in individuals over 65. (see NPR 2023 article above where an Emergency Physician states, "some wish to avoid CPR and instead prefer allowing natural death."
NOTE: This is not an official form for you to fill out, it’s only a sample for educational purposes. You get an official POLST when you visit your doctor.
ADVANCE DIRECTIVES
The advance directive is a legal form that lets you name a person to make your health care decisions if you cannot make them for yourself. It allows you to write down your goals and wishes for health care to make them known. This is in the event you are not able to express them in the future.
Every person should strongly consider having an Advanced Directive so that family and medical personnel do not have to guess your preferences for care.
PLEASE NOTE: In some of the resources we are providing, you will see language reflecting the “ill and frail” criteria for POLST. We are including these documents because they contain other valuable information. The M&C committee has provided additional information about the outcome of CPR in individuals over 65 (see this NPR 2023 article where an Emergency Physician states, "some wish to avoid CPR and instead prefer allowing natural death."
DIFFERENCES BETWEEN POLSTS AND ADVANCE DIRECTIVES
Estate Planning slide show - Eric J. Wieland, J.D., LL.M, 7/32/2025 – how each one fits in your estate plan from an estate lawyer’s perspective.
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