Published on July 14, 2025
Updated on July 10, 2025
Table of Contents
When most people think about filling out a POLST form, they naturally want to start with Section A—the part about CPR. It makes sense, right? That’s where the form begins. But here’s what hospice professionals have learned after years of helping families through this process: starting with Section A is like trying to build a house without laying the foundation first.
The revolutionary approach first discussed by Jose Escobar of Polaris Support Global, which is changing how we help families make these important decisions, is simple: start with “D” instead of “A.” This isn’t just a different way of filling out paperwork—it’s an entirely different way of thinking about what matters most when someone you love is facing a serious illness.
Think about it this way: when you’re making any important decision in life, you don’t start with the technical details. You start with who you trust and what matters most to you. The same principle applies to POLST planning, but somehow we’ve gotten it backward.
Traditional POLST conversations often go like this: “Do you want CPR if your heart stops?” But that question is impossible to answer meaningfully without first understanding your values, your goals, and who will speak for you if you can’t speak for yourself.
The “start with D” approach flips this around. Instead of beginning with medical procedures, we begin with relationships and values. We start by asking: “Who knows you well enough to make decisions that honor what matters most to you?” This single shift changes everything about how the conversation unfolds.
When families start with Section D—choosing their healthcare decision-maker—they’re actually doing something much more profound than filling out a form. They’re identifying their voice for times when they can’t speak for themselves. They’re choosing someone who will fight for their values, not just follow medical protocols.
Here’s what many people don’t realize: advance care planning isn’t really about predicting the future or making perfect medical decisions. It’s about making sure your voice is heard when you can’t speak for yourself.
Your Voice means more than just your medical preferences. It includes your fears, your hopes, what gives your life meaning, and what you absolutely cannot tolerate. When you start with choosing your decision-maker, you’re ensuring that someone who truly knows your voice will be there to speak for you.
Clarity comes from having honest conversations about what you value most. Maybe you’re someone who would want every possible treatment if there’s even a small chance of recovery. Or maybe you’re someone who values comfort and peace above all else. Neither choice is right or wrong—but both require clarity about what matters to you.
Control doesn’t mean controlling everything that happens to you medically. That’s impossible. Real control means controlling who makes decisions for you and ensuring they understand what you would want. It means having a say in how your story ends, even when you can’t write the final chapters yourself.
When families understand that POLST planning is really about preserving voice, clarity, and control, the entire process becomes less frightening and more empowering. Instead of feeling like they’re giving up, they realize they’re taking charge of what they can control.
When you start with Section D, something beautiful happens: the rest of the form begins to make sense. Instead of abstract medical questions, each section becomes a conversation about how to honor what you’ve already identified as important.
Let’s say you’ve chosen your daughter as your healthcare decision-maker because she’s the one who really understands that your independence matters more to you than anything else. Now, when you get to Section C about nutrition and hydration, the question isn’t just “Do you want a feeding tube?” The question becomes, “Would a feeding tube help you maintain the independence that matters so much to you, or would it take that away?”
Starting with your decision-maker also reduces family conflict later. When everyone knows that Mom chose Sarah as her healthcare agent because Sarah best understands Mom’s values, it’s easier for other family members to support Sarah’s decisions, even when they’re difficult.
This approach also helps healthcare teams provide better care. Instead of just following medical orders, they understand the person behind the decisions. They know that when John chose comfort measures, it wasn’t because he was giving up—it was because he valued being present with his family more than being in a hospital.
The “start with D” approach recognizes a simple truth: good medical decisions flow from good relationships and clear values. When you begin by identifying who knows you best and what matters most to you, every other decision becomes clearer, more meaningful, and more likely to truly honor who you are as a person.
This isn’t just a better way to fill out a form—it’s a better way to ensure that your end-of-life care reflects your life’s values. And that changes everything.
Choosing your healthcare agent is your most important decision in your POLST planning. This person becomes your voice when you can’t speak for yourself. They’re not just signing a piece of paper—they’re promising to fight for what matters most to you, even when it’s hard.
Many people think they should choose their healthcare agent based on who lives closest to them or who has medical knowledge. But hospice professionals know that the best healthcare agents are chosen for their heart, not their medical degree.
Your healthcare agent isn’t there to make medical decisions—that’s what doctors and nurses do. Your agent is there to make sure the medical team understands you as a person. They’re there to say, “Mom would never want to be kept alive on machines,” or “Dad always said he wanted to fight until the very end.” They translate your values into medical decisions.
Think about it this way: if you were unconscious in the hospital, who would you want sitting beside your bed, holding your hand, and making sure the doctors understood what kind of person you are? That’s your healthcare agent.
Your healthcare agent becomes your advocate, your protector, and your voice. They don’t need to understand every medical term, but they absolutely need to understand what makes life meaningful to you.
The most crucial quality in a healthcare agent isn’t medical knowledge—it’s deep knowledge of your values. A good healthcare agent can learn medical information from doctors, but they can’t learn your heart from a textbook.
Not everyone is cut out to be a healthcare agent, and that’s okay. This role requires specific qualities that not all family members or friends possess. Here’s what to look for:
Someone Who Knows Your Values Deeply: Your ideal healthcare agent is the person who really “gets” you. They understand what you mean when you say, “I don’t want to be a burden” or “I want to fight this thing.” They know the difference between your fears and your actual wishes. They’ve heard you talk about what makes life worth living, and they remember those conversations.
Stays Calm During Crisis Situations: Medical emergencies are chaotic and emotional. Your healthcare agent needs to be someone who can think clearly under pressure. This doesn’t mean they can’t feel sad or scared—it means they can still make decisions that honor your wishes even when their emotions are running high.
Will Honor Your Wishes Even When It’s Emotionally Difficult: This might be the most challenging part of being a healthcare agent. Sometimes, honoring your wishes means making decisions that feel like “giving up” to other family members. Your agent needs to be strong enough to say, “This is what she wanted,” even when others disagree.
The Importance of Having a Backup Decision-Maker: Life happens. Your first choice might be traveling, being sick, or simply too overwhelmed to make decisions. Always choose a backup healthcare agent—someone who knows your values almost as well as your first choice. Make sure both people understand your wishes and can work together if needed.
Some people aren’t good choices for healthcare agents, even if you love them dearly:
Once you’ve chosen your healthcare agent, the real work begins. This isn’t a one-time conversation—it’s an ongoing relationship that requires honesty, trust, and regular communication.
Discussing Your Values and What Matters Most to You: Start by talking about what makes your life meaningful. Share stories about times when you felt most like yourself. Talk about what you absolutely couldn’t tolerate and what you’d be willing to endure if there was hope for recovery. These conversations help your agent understand not just your medical preferences but the person behind those preferences.
Help them understand your definition of a “good death.” For some people, that means being surrounded by family at home. For others, it means fighting in the ICU until the very end. Neither is right nor wrong, but your agent must know which reflects your values.
Sharing Your Fears and Hopes About End-of-Life Care: Be honest about what scares you most. Is it pain? Being alone? Being a burden on your family? Losing your independence? Your healthcare agent can’t protect you from everything, but they can make sure your care team addresses your biggest fears.
Also, share your hopes. Maybe you hope to see one more grandchild born, or to make it to your 50th wedding anniversary. Your agent can help medical teams understand these goals and make treatment decisions that support what matters most to you.
Ensuring They Understand the Weight of This Responsibility: Being a healthcare agent is both an honor and a burden. Make sure your chosen person truly understands what you’re asking of them. They need to know that someday, they might have to make life-and-death decisions on your behalf. They need to understand that other family members might disagree with their choices and must stay strong in honoring your wishes.
Let them know it’s okay to ask questions, to need time to think, or even to say no if they don’t feel capable of taking on this responsibility. It’s better to have this honest conversation now than to discover later that they’re unprepared for the role.
Regular Check-Ins to Keep Them Informed About Your Wishes: Your values and preferences might change as your health changes or as you age. Schedule regular conversations with your healthcare agent—maybe once a year or whenever your health situation changes significantly.
During these check-ins, talk about any new health diagnoses, changes in your family situation, or shifts in what matters most to you. Make sure your agent knows about any updates to your POLST form or other advance directives.
Remember, choosing a healthcare agent is about choosing someone who will honor your voice when you can’t use it yourself. Take time to choose wisely, communicate clearly, and maintain that relationship over time. Your future self—and your family—will be grateful you did.
When families face Section C of the POLST form—decisions about nutrition and hydration—they’re often confronting one of the most emotionally challenging aspects of end-of-life care. This section isn’t just about medical procedures; it’s about love, comfort, and letting go of the need to “fix” everything with food and fluids.
There’s a beautiful truth that hospice professionals have learned over decades of caring for dying patients: “Near the end of life, feeding is love. But comfort is safety.” This simple phrase captures the heart of why nutrition decisions become so complex when someone is seriously ill.
Throughout our lives, food represents care, celebration, and connection. When someone we love is sick, our instinct is to nourish them back to health. We want to make their favorite soup, encourage them to drink more water, or ensure they’re getting enough calories. This comes from a place of deep love—but near the end of life, what feels like love can sometimes cause harm.
Why IV Fluids and Feeding Tubes Often Don’t Help in Late-Stage Illness: When the body is shutting down due to advanced illness, it naturally loses the ability to process food and fluids the way it once did. The digestive system slows down, the kidneys work less efficiently, and the body’s need for calories decreases dramatically. Adding artificial nutrition or IV fluids to a system that’s naturally winding down can create serious problems.
Think of it this way: if you tried to pour a gallon of water into a cup that only holds eight ounces, the water would overflow and create a mess. The same thing happens when we give IV fluids or tube feeding to someone whose body can no longer process them properly.
The Medical Risks: Aspiration, Fluid Overload, and Increased Discomfort: When families choose artificial nutrition or hydration for someone who’s dying, they often unknowingly increase their loved one’s suffering. Aspiration happens when food or fluids go into the lungs instead of the stomach, causing pneumonia and breathing problems. Fluid overload occurs when the body can’t process extra fluids, leading to swelling, difficulty breathing, and increased secretions that make the person feel like they’re drowning.
These complications don’t just cause physical discomfort—they often require more medical interventions, more time in the hospital, and less peaceful final days. The very thing families hoped would help their loved one often creates the opposite of what they wanted.
The medical evidence about artificial nutrition and hydration at the end of life is clear and consistent: these interventions rarely help and often cause harm.
Research Findings on Artificial Nutrition in Advanced Illness: Major medical organizations, including the American Academy of Hospice and Palliative Medicine, have reviewed decades of research on artificial nutrition and hydration. Their findings are sobering but important for families to understand:
How Artificial Nutrition Rarely Prolongs Life and Often Increases Suffering: One of the hardest truths for families to accept is that artificial nutrition doesn’t bring someone back to health when they’re dying from a terminal illness. The body is shutting down because of the disease process, not because of a lack of food or fluids. Adding artificial nutrition to this process is like trying to restart a car that’s out of gas by polishing the hood—it doesn’t address the real problem.
Studies consistently show that people with advanced illnesses who receive artificial nutrition don’t live longer than those who receive comfort feeding only. However, they do experience more complications, more discomfort, and less peaceful deaths.
Balancing Family Emotions with Medical Reality: Understanding this research doesn’t make the emotional aspect any easier. Families often feel like they’re “starving” their loved one if they choose not to pursue artificial nutrition. This guilt is real and understandable, but it’s based on a misunderstanding of what’s actually happening in the body during the dying process.
The reality is that people who are dying naturally lose their appetite and thirst. This isn’t distressing to them—it’s their body’s way of preparing for death. Forcing nutrition at this stage can actually cause more discomfort than allowing the natural process to unfold.
Understanding when artificial nutrition might be appropriate versus when comfort feeding is the better choice requires honest conversations about goals, prognosis, and what “comfort” really means.
When Artificial Nutrition Might Be Appropriate: There are limited situations where artificial nutrition might align with a person’s goals and values:
However, these situations are rare in the context of advanced, terminal illness. Most of the time, artificial nutrition at the end of life causes more problems than it solves.
Understanding Comfort Feeding Versus Medical Intervention: Comfort feeding focuses on the person’s enjoyment and comfort rather than on getting a certain number of calories or ounces of fluid. It might include:
This approach honors the person’s dignity and autonomy while avoiding the complications that come with forced feeding or artificial nutrition.
Supporting Family Members Through Difficult Nutrition Choices: Making nutrition decisions requires families to shift from thinking about “feeding to cure” to “feeding for comfort.” This mental shift can be incredibly difficult, especially for family members who have spent years caring for their loved one.
Some families find it helpful to reframe their thinking this way: “We’re not withholding food—we’re withholding suffering.” Others find comfort in focusing on other ways to show love and care, like providing mouth care, playing favorite music, or simply being present.
The key is understanding that choosing comfort feeding over artificial nutrition isn’t giving up—it’s choosing a different kind of care that prioritizes peace and dignity over medical interventions that won’t change the outcome.
When families understand that their loved one’s body is naturally preparing for death, they can make nutrition decisions that truly serve their loved one’s comfort and honor their values, rather than decisions based on fear or misunderstanding about what’s actually happening in the dying process.
When families choose Section B’s comfort-focused treatment option, they’re choosing what hospice and palliative care teams do best: providing intensive care that focuses on the person, not just the disease. This approach represents a fundamental shift from “cure at all costs” to “care that honors what matters most.”
Comfort-focused care isn’t about giving up or doing nothing—it’s about doing everything that truly helps while avoiding interventions that cause more suffering than relief. This approach requires just as much medical expertise, attention, and dedication as any other form of healthcare. The difference is in the goals and methods.
What Hospice and Palliative Care Teams Prioritize: Hospice and palliative care professionals are trained to see the whole person, not just their medical condition. They prioritize quality of life over quantity of life, which means every decision is filtered through the question: “Will this help this person live as well as possible for whatever time they have left?”
These teams understand that comfort isn’t just about physical pain—it’s about emotional peace, spiritual well-being, and maintaining dignity and connection with loved ones. They know that a person can be comfortable and still be fighting—they’re just fighting for different things than a cure.
Treating Pain, Breathlessness, and Emotional Distress Effectively: Comfort-focused care teams are experts at managing the symptoms that matter most to dying patients. They understand that uncontrolled pain, difficulty breathing, and emotional distress can rob someone of their ability to connect with family, find peace, or experience joy in their final days.
These professionals have specialized training in pain management that goes far beyond what most people experience in regular medical care. They know how to use medications effectively, how to adjust treatments as conditions change, and how to address the complex interactions between physical and emotional suffering.
Why Intensive Doesn’t Mean Invasive: One of the biggest misconceptions about comfort care is that it’s “less intensive” than other forms of medical care. The truth is that comfort-focused care can be incredibly intensive—it’s just intensive in different ways. Instead of intensive monitoring in an ICU, it might mean intensive attention to pain management, family dynamics, and spiritual needs.
A hospice nurse might visit daily to adjust medications, provide hands-on care, and support family members through the emotional challenges of caregiving. A palliative care team might coordinate with multiple specialists to ensure every aspect of a person’s comfort is addressed. This level of attention and care is intensive—it’s just focused on comfort rather than cure.
Comfort-focused care is comprehensive and addresses every aspect of a person’s well-being. It’s built on the understanding that true comfort requires attention to physical, emotional, social, and spiritual needs.
Comprehensive Pain Management: Pain management in comfort care goes far beyond simply prescribing medication. It includes:
The goal isn’t just to reduce pain—it’s to reduce pain enough that the person can focus on what matters most to them, whether that’s spending time with family, completing important projects, or simply finding peace.
Symptom Control for Breathing Difficulties: Shortness of breath is one of the most frightening symptoms for both patients and families. Comfort care teams are experts at managing breathing problems through:
The focus is always on how the person feels, not just what medical tests show. If someone feels like they can’t breathe, that distress is addressed even if their oxygen levels look normal on paper.
Emotional and Spiritual Support: Comfort care recognizes that emotional and spiritual pain can be just as devastating as physical pain. This support includes:
Family Education and Support: Families are considered part of the care team in comfort-focused care. This means:
Understanding what comfort care avoids is just as important as understanding what it includes. These decisions aren’t about being “less caring”—they’re about being more selective about which interventions actually serve the person’s goals.
Unnecessary Hospital Trips That Cause More Distress: Hospital emergency rooms are designed to save lives through aggressive interventions. For someone who’s choosing comfort care, a trip to the ER often results in treatments that go against their stated wishes. Comfort care teams work hard to manage crises at home or in other comfortable settings whenever possible.
This doesn’t mean never going to the hospital—it means going to the hospital only when it will genuinely improve comfort or quality of life. For example, someone might go to the hospital for a procedure to relieve a bowel obstruction that’s causing severe pain, but they wouldn’t go for CPR or intensive care interventions.
Intubation and Interventions That Increase Suffering: Comfort care avoids medical interventions that are more likely to cause suffering than relief. This includes:
Treatments That Cause More Harm Than Relief: Every medical intervention has risks and benefits. In comfort care, the bar for benefits is higher and the tolerance for risks is lower. If a treatment has a small chance of helping but a high chance of causing discomfort, it’s usually not pursued.
The Difference Between “Doing Less” and “Doing What Helps Now:” Perhaps the most important thing to understand about comfort care is that it’s not about “doing less”—it’s about doing what actually helps in this moment, for this person, given their specific situation and goals.
A comfort care team might provide more frequent nursing visits, more comprehensive pain management, and more family support than someone receives in a hospital. They’re not doing less—they’re doing different things, things that are specifically chosen to improve quality of life rather than extend life at any cost.
This approach requires families to shift their thinking from “Are we doing everything possible?” to “Are we doing everything that helps?” This profound difference can transform the entire experience of serious illness from a medical battle to a journey focused on comfort, connection, and peace.
When families reach Section A of the POLST form—the decision about CPR—they’re facing one of the most emotionally charged choices in all of healthcare. This isn’t just a medical decision; it’s a decision about how someone’s story ends and what kind of fight they want to have in their final moments.
The CPR we see on television shows and in movies bears little resemblance to the reality of CPR in real life, especially for people with advanced illness. Understanding the true facts about CPR is essential for making an informed decision that honors what matters most to you or your loved one.
Survival Rates Under 1% for CPR in Advanced Illness: The statistics about CPR survival are sobering but essential. For people with advanced cancer, heart failure, kidney disease, or other serious illnesses, the chance of surviving CPR and leaving the hospital is less than 1%. This means that out of 100 people with advanced disease who receive CPR, fewer than one will survive to go home.
Even more important than survival rates is the quality of life after CPR. Of the very few people who do survive CPR in the context of advanced illness, most experience significant brain damage, require long-term care, and never return to their previous level of functioning. The CPR that families hope will bring their loved one back often brings back someone very different from the person they knew.
Physical Consequences: Broken Ribs, ICU Stays, Ventilators: CPR is a violent, traumatic procedure that’s designed to restart a heart that has stopped beating. Effective chest compressions break ribs—this isn’t a complication, it’s an expected part of the process. The force required to compress the chest enough to circulate blood is enormous, especially for older adults with more fragile bones.
When someone receives CPR, they typically end up in the intensive care unit connected to a ventilator, with tubes and wires attached to their body. Even if their heart starts beating again, they’re often unconscious and unable to communicate with family members. The final days or weeks become focused on machines and medical procedures rather than connection and comfort.
Why “Do Not Attempt Resuscitation” Isn’t Giving Up: Choosing “Do Not Attempt Resuscitation” (DNAR) isn’t about giving up—it’s about choosing a different kind of care when the heart stops. Instead of chest compressions and electric shocks, it means choosing comfort measures: holding hands, speaking words of love, and allowing natural death to occur peacefully.
Many families worry that choosing DNAR means their loved one won’t receive other medical care. This isn’t true. DNAR only applies to CPR when the heart stops. It doesn’t affect treatment for pain, breathing problems, infections, or any other medical issues. Someone with a DNAR order can still receive aggressive treatment for their underlying condition if that aligns with their goals.
To make an informed decision about CPR, families need to understand exactly what this procedure involves and what the realistic outcomes are for someone with advanced illness.
The Physical Reality of Chest Compressions: CPR involves pushing hard and fast on the chest at least 100 times per minute. The person performing CPR must press down at least 2 inches into the chest with each compression. For an adult, this requires significant force—enough force to break ribs and potentially damage internal organs.
During CPR, the person is unconscious and unresponsive. There’s no opportunity for final words, peaceful goodbyes, or spiritual comfort. The focus is entirely on the medical procedure, with family members typically asked to leave the room while the medical team works.
If the heart starts beating again, the person is usually intubated (a breathing tube is inserted down their throat) and connected to a ventilator. They may remain unconscious for days or weeks, and many never regain consciousness at all.
Recovery Expectations Versus Medical Reality: Television and movies have created unrealistic expectations about CPR recovery. On TV, people who receive CPR often wake up quickly, talk to their families, and return to normal life. In reality, the recovery process is long, difficult, and often incomplete.
Even in the best-case scenario, someone who survives CPR typically faces:
For people with advanced illness, these outcomes are even more unlikely. Their bodies are already weakened by disease, making recovery from the trauma of CPR nearly impossible.
How Age and Frailty Affect CPR Outcomes: Age and frailty dramatically affect CPR outcomes. Older adults and people with multiple medical conditions are much less likely to survive CPR, and when they do survive, they’re more likely to experience serious complications.
Frail older adults often have:
Understanding these realities doesn’t mean that older adults should never choose CPR, but it does mean that the decision should be based on realistic expectations rather than hope for outcomes that are extremely unlikely.
When families understand the reality of CPR in advanced illness, many choose to fight a different kind of battle—one focused on comfort, dignity, and connection rather than medical interventions that are unlikely to help.
Fighting for Peace, Comfort, and Dignity Instead: Choosing not to have CPR doesn’t mean choosing not to fight. It means choosing to fight for different things: a peaceful death, freedom from pain, time with loved ones, and the ability to die with dignity intact.
This kind of fight might involve:
These battles are just as important as medical battles and are often more winnable. A person can achieve peace, comfort, and dignity even when they can’t achieve a cure.
Understanding That Saying No to CPR Can Be Saying Yes to Better Care: When someone chooses DNAR, they’re often saying yes to a different kind of care—care that’s focused on their comfort and their family’s needs rather than on medical procedures that are unlikely to help.
This might mean:
Supporting Families Through CPR Decision-Making: Making decisions about CPR is emotionally difficult for families. Many people feel like they’re “killing” their loved one by choosing DNAR, even when they understand that CPR is unlikely to help.
It’s important for families to understand that choosing DNAR is often the most loving choice they can make. It’s choosing to spare their loved one from a traumatic procedure that’s unlikely to help and instead focusing on comfort and connection in their final moments.
Some families find it helpful to think about it this way: “We’re not choosing death—death is already coming because of the illness. We’re choosing how we want to meet death—with medical trauma or with peace and dignity.”
The decision about CPR is ultimately about values: What matters most in the final moments of life? Is it the slim chance of medical intervention working or the certainty of comfort, love, and peace? Neither choice is right or wrong, but both deserve to be made with full understanding of what each option really means.
The heart of good POLST planning isn’t about medical procedures—it’s about understanding what makes life meaningful to you and ensuring your medical care honors those values. This values-based approach transforms POLST from a confusing medical form into a powerful tool for protecting what matters most.
Before diving into specific medical decisions, take time to explore the deeper questions that will guide every choice on your POLST form. Your values are your compass—they help you navigate difficult decisions by keeping you focused on what truly matters to you.
Exploring Your Personal Values Before Making Medical Decisions: Values aren’t abstract concepts—they’re the things that make you who you are. Think about the moments in your life when you felt most like yourself. What was happening? What made those times special? These experiences reveal your core values and can guide your medical decisions.
Some people value independence above all else. They’d rather have a shorter life where they can make their own choices than a longer life where others have to care for them. Others value connection and would choose treatments that give them more time with family, even if those treatments are complex.
Neither approach is right nor wrong. The right choice is the one that aligns with your personal values. A person who values adventure and spontaneity might make very different POLST choices than someone who values security and predictability.
Take time to think about what you absolutely couldn’t tolerate and what you’d be willing to endure if it meant achieving something important to you. These aren’t easy questions, but they’re essential for making medical decisions that truly reflect who you are.
Understanding Your Definition of Quality of Life: Quality of life means different things to different people. For some, it’s about being pain-free and comfortable. For others, it’s about being able to think clearly and communicate with loved ones. Still others define quality of life as being able to contribute to their family or community in some way.
Your definition of quality of life should drive your POLST decisions. If being able to communicate is essential to your quality of life, you might choose different treatments than someone whose priority is simply being free from pain.
Think about what would make life not worth living for you. This isn’t a morbid question—it’s a practical one that helps you set boundaries around the kinds of treatments you’d want. Some people say they couldn’t tolerate being dependent on others for basic care. Others say they couldn’t handle being in constant pain or being unable to recognize their family members.
Discussing Fears and Hopes Openly with Your Healthcare Team: Your healthcare team can’t help you make good decisions if they don’t understand what you’re afraid of and what you’re hoping for. Be honest about your fears—whether it’s pain, being alone, being a burden on your family, or losing your dignity.
Also, share your hopes. Maybe you hope to see a grandchild graduate, to reconcile with an estranged family member, or simply to have one more good day with your spouse. These hopes can help your healthcare team understand what treatments might be worth pursuing and which ones might interfere with what you’re trying to achieve.
Remember that your healthcare team has probably heard every fear and hope imaginable. There’s nothing too personal or too frightening to discuss. The more they understand what matters to you, the better they can help you make decisions that honor your values.
The best POLST conversations start with a simple but powerful statement: “We want your care to match what matters most to you.” This approach puts your values at the center of every decision and ensures that medical recommendations align with your personal goals.
Questions to Ask Your Healthcare Provider: Good conversations require good questions. Here are some essential questions that can help you understand your situation and make informed decisions:
How to Involve Family Members Appropriately: Family involvement in POLST conversations can be incredibly helpful, but it’s vital to maintain clear boundaries about who makes the final decisions. If you’re the patient, these are ultimately your choices to make. If you’re a healthcare agent, your job is to honor the patient’s values, not to impose your own.
Family members can help by:
However, family members shouldn’t:
Working Through Disagreements with Compassion: Family disagreements about POLST decisions are common and understandable. Everyone wants what’s best for their loved one, but people often have different ideas about what “best” means.
When disagreements arise, focus on the patient’s values rather than specific medical decisions. Ask questions like: “What would Mom want in this situation?” rather than “What do we think is best for Mom?” The goal is to honor the patient’s voice, not to reach a consensus among family members.
Sometimes it helps to involve a neutral party—like a social worker, chaplain, or family counselor—to facilitate difficult conversations. These professionals can help families communicate more effectively and find common ground even when they have different perspectives.
Making good POLST decisions requires honest, clear information about your medical condition and realistic expectations about what different treatments can and cannot achieve.
Getting Clear Information About Your Prognosis: Prognosis—information about what to expect from your illness—is often the most difficult topic for both patients and healthcare providers to discuss. Many doctors struggle with giving bad news, and many patients and families aren’t sure they want to hear it. But you can’t make good decisions without good information.
Ask your healthcare provider to be specific about timeframes when possible. Instead of accepting vague statements like “you have some time left,” ask questions like: “Are we talking about weeks, months, or years?” or “What would surprise you—if I lived longer than six months or shorter than six months?”
Remember that prognosis is always uncertain. Your healthcare provider is giving you their best estimate based on medical knowledge and experience, but individual cases can vary significantly from average expectations.
Understanding Treatment Options and Their Realistic Outcomes: For each treatment option you’re considering, ask about both benefits and burdens. Benefits aren’t just about whether a treatment might extend life—they include improvements in symptoms, function, and quality of life.
Burdens include not just side effects, but also the impact on your daily life, your family’s life, and your ability to do things that matter to you. A treatment that requires frequent hospital visits might not be worth it if being at home with family is your top priority.
Ask about realistic timelines for seeing benefits from treatment. Some treatments take weeks or months to show results, and it’s essential to know whether you’re likely to live long enough to experience those benefits.
Balancing Hope with Honest Medical Information: One of the most challenging aspects of POLST planning is maintaining hope while accepting difficult medical realities. Hope and honesty aren’t opposites—you can hope for the best while planning for other possibilities.
Hope might shift from hoping for a cure to hoping for more good days, from hoping to live longer to hoping to live better, or from hoping to beat the illness to hoping for a peaceful death surrounded by loved ones. All of these hopes are valid and important.
The goal isn’t to eliminate hope, but to ensure that your hopes are informed by realistic medical information. This allows you to make POLST decisions that give you the best chance of achieving what you’re hoping for, whatever that might be.
Remember that values-based decision-making is an ongoing process. Your values might evolve as your situation changes, and that’s perfectly normal. The important thing is to keep coming back to what matters most to you and ensure that your medical care continues to honor those values throughout your journey.
Understanding who can legally complete a POLST form and how the process should work is essential to ensure your wishes are documented and legally valid. The POLST completion process is highly regulated to protect patients and provide quality care.
POLST forms aren’t just paperwork that anyone can fill out—they’re medical orders that carry the same legal weight as prescriptions. Only specific healthcare professionals with the proper training and authority can complete and sign them.
Only MDs, DOs, NPs, or PAs Can Complete and Sign POLST Forms: The law is very clear about who can create a valid POLST form. Only these four types of healthcare providers can legally complete and sign POLST forms:
These professionals must have a treating relationship with you, which means they know your medical condition, understand your prognosis, and are involved in your care. A random doctor who doesn’t know you cannot complete your POLST form, even if they’re qualified to do so.
The Role of End-of-Life Professionals in Education (Not Completion): While only certain healthcare providers can complete POLST forms, many other professionals play crucial roles in helping you prepare for the conversation. End-of-life doulas, hospice nurses, hospice social workers, and other care team members often help patients and families in these critical ways:
However, these professionals cannot complete the actual POLST form. Their role is to educate, support, and prepare—not to create the medical orders themselves.
Understanding Scope of Practice Requirements: Each healthcare profession has specific rules about what they can and cannot do, which is called “scope of practice.” POLST completion falls within the scope of practice only for physicians, nurse practitioners, and physician assistants because it involves creating medical orders based on complex medical decision-making.
This doesn’t mean other professionals are less important—it means the healthcare system has clear rules about who can make which types of medical decisions. A hospice social worker might understand your values better than anyone, but they cannot legally translate those values into medical orders. That’s the job of your physician or other qualified provider.
Healthcare providers who complete POLST forms should follow specific best practices to ensure the process honors your values and creates a meaningful document that truly reflects your wishes.
Asking About Values Early in the Process: The best POLST conversations start with your values, not with medical procedures. Your healthcare provider should ask questions like: “What makes life meaningful to you?” or “What are you most afraid of as your illness progresses?” before diving into specific medical decisions.
This approach helps ensure that every choice on your POLST form connects back to what matters most to you. When providers understand your values first, they can explain medical options in ways that help you make decisions that truly reflect who you are.
Focusing on Patient-Centered Care Goals: Your healthcare provider should focus on your goals for your care, not just medical outcomes. Maybe your goal is to be comfortable and peaceful, or perhaps it’s to fight for every possible day with your family. Neither goal is right or wrong, but your POLST should reflect whichever goal is yours.
Patient-centered care means your provider takes time to understand not just your medical condition, but also your fears, hopes, family situation, and personal values. They should explain medical options in the context of your specific goals, not just provide generic information about treatments.
Remembering That Advance Directives Are Living Documents: Good healthcare providers understand that your POLST isn’t carved in stone. Your values might evolve, your medical condition might change, or you might simply change your mind about what you want. Your provider should remind you that you can update your POLST anytime and should encourage you to review it regularly.
They should also make sure you understand that having a POLST doesn’t mean you’re “giving up” or that you can’t change course if your situation changes. A POLST is a snapshot of your current wishes based on your current situation—it can and should be updated as needed.
Even though your healthcare provider completes the form, you play a crucial role in making sure it accurately reflects what you want. Here’s how to ensure your POLST truly represents your wishes.
Reviewing Each Section Carefully: Don’t just trust that your provider got everything right—ask them to walk through each section of the completed form with you. Make sure you understand what each choice means and that it aligns with what you discussed.
Ask questions like: “Can you explain what this choice means in practical terms?” or “How does this decision connect to the values we talked about?” If anything doesn’t make sense or doesn’t feel right, speak up. This is your form, and it should reflect your wishes, not what your provider thinks you should want.
Making Sure Your Choices Align with Your Stated Values: Look at your completed POLST form and ask yourself: “Do these choices honor what I said was most important to me?” If you said that being able to communicate with your family was your top priority, do your POLST choices support that goal? If you said you wanted to avoid being a burden, do your choices reflect that value?
Sometimes, there are conflicts between different values or goals. For example, you might want to avoid being a burden and spend as much time as possible with your family. Work with your provider to find choices that honor your most important values, even if you can’t achieve everything you want.
Understanding That You Can Change Your Mind: One of the most important things to understand about POLST is that you can change it anytime you want. You don’t need a “good reason” to change your mind—your preferences are allowed to evolve as your situation changes.
If you want to update your POLST, contact your healthcare provider to schedule a conversation about revising it. You’ll need to complete a new form (you can’t just cross out parts of the old one), and your provider will mark the old form as void to avoid confusion.
Keeping Your POLST Accessible When Needed: A perfect POLST form doesn’t help if no one can find it during an emergency. Make sure copies of your POLST are available where they’re most likely to be needed:
Your POLST is only as good as your ability to access it when needed. Take time to think through different scenarios and make sure your form is available in each situation where it might be important.
Remember, the goal of all these best practices is to create a POLST form that truly honors your values and wishes. This isn’t just about following rules or completing paperwork—it’s about ensuring that your voice is heard and your values are honored, especially during times when you might not be able to speak for yourself.
POLST planning rarely happens in a vacuum—it involves families with different perspectives, emotions running high, and complex medical information that can be difficult to understand. These challenges are normal and expected, but knowing how to navigate them can make the difference between a process that brings families together and one that drives them apart.
Family disagreements during POLST planning are incredibly common. Everyone loves the patient and wants what’s best, but people often have very different ideas about what “best” means. These disagreements can feel overwhelming, but they’re manageable with the right approach.
Strategies for Family Discussions: The key to productive family discussions is focusing on the patient’s values rather than your own preferences. Start every conversation by asking: “What would Mom want in this situation?” rather than “What do we think is best for Mom?”
Establish some ground rules to create a safe space for these discussions. Everyone gets to speak without interruption, and no one’s feelings are dismissed as “wrong” or “selfish.” Sometimes, it helps to have one person facilitate the conversation—someone who can keep the discussion focused and ensure everyone’s voice is heard.
Try to understand why family members feel the way they do. The brother who wants “everything done” might be processing his own fear of loss, while the sister who wants comfort care might be trying to protect their mother from suffering. Both perspectives come from love, even when they lead to different conclusions.
The Role of the Designated Decision-Maker: When family members can’t agree, the designated healthcare agent has the final say. This can be difficult for other family members to accept, especially if they disagree with the agent’s decisions. It’s important to remember that the healthcare agent’s job isn’t to make decisions that please everyone—it’s to make decisions that honor the patient’s values and wishes.
If you’re the healthcare agent, remind family members that you’re not imposing your own preferences. You’re trying to honor what the patient would want based on conversations you’ve had with them. Be willing to explain your reasoning, but don’t feel like you need everyone’s approval to make decisions.
If you’re not the healthcare agent but disagree with their decisions, try to focus on whether the decision aligns with the patient’s stated values rather than whether it aligns with your own preferences. The goal is to honor the patient’s voice, not to reach a family consensus.
When to Seek Additional Support or Mediation: Sometimes, family disagreements become so intense that they interfere with the patient’s care or cause significant distress. This is when it’s time to seek outside help. Many hospitals and hospice organizations have social workers, chaplains, or patient advocates who are trained to help families work through difficult decisions.
Professional mediation can be incredibly helpful when families are stuck. A neutral mediator can help family members communicate more effectively and find common ground that they might not have discovered on their own. Mediation isn’t about one side “winning”—it’s about finding solutions that honor the patient’s wishes while addressing family concerns.
Don’t wait until conflicts become destructive to seek help. Early intervention often prevents small disagreements from becoming major family rifts that can last long after the patient has died.
The emotions surrounding POLST planning can be intense and overwhelming. These feelings are completely normal, but they can make it difficult to think clearly and make good decisions. Understanding and addressing these emotional barriers is essential for effective POLST planning.
Processing Grief and Loss During Planning: POLST planning often forces families to confront the reality that their loved one is dying. This can trigger anticipatory grief—the sadness and loss you feel before someone actually dies. You might find yourself grieving not just the future loss of your loved one, but also the loss of the person they used to be before illness changed them.
It’s important to acknowledge these feelings rather than trying to push them aside. Grief is a natural response to loss, and trying to ignore it often makes decision-making more difficult. Allow yourself and other family members to feel sad, angry, or scared. These emotions don’t mean you’re weak—they mean you love someone who’s facing a difficult situation.
Managing Fear and Anxiety About the Future: Fear about what’s coming can paralyze decision-making. You might be afraid of making the “wrong” choice, afraid of your loved one suffering, or afraid of what life will be like after they’re gone. These fears are understandable, but they shouldn’t control your decisions.
Try to identify what specifically you’re afraid of. Are you worried about pain? About your loved one dying alone? About making decisions they wouldn’t want? Once you name your fears, you can address them more directly. Talk to healthcare providers about pain management, discuss how to ensure your loved one won’t be alone, and have honest conversations about their wishes.
Finding Hope Within Realistic Expectations
One of the most challenging aspects of POLST planning is balancing hope with acceptance of medical reality. Hope and honesty aren’t opposites—you can hope for good days while also planning for difficult ones. You can hope for more time while also ensuring that whatever time remains is as comfortable and meaningful as possible.
Hope might need to shift as circumstances change. Early in an illness, you might hope for a cure. Later, you might hope for more good days, or for a peaceful death surrounded by loved ones. All of these hopes are valid and important.
Supporting Each Other Through Difficult Conversations: Family members need to support each other through the emotional challenges of POLST planning. This means being patient with each other’s different ways of processing difficult information. Some people need time to think before making decisions, while others want to decide quickly. Some people cope by gathering lots of information, while others prefer to focus on emotional and spiritual aspects.
Recognize that everyone is doing their best in a difficult situation. Offer practical support, such as taking notes during medical appointments, helping with research, or simply being present during difficult conversations. Sometimes, the most supportive thing you can do is listen without trying to fix or change how someone else is feeling.
Clear communication is essential for good POLST planning, but many factors can make communication difficult. Understanding these challenges and knowing how to address them helps ensure that everyone involved truly understands the decisions being made.
Overcoming Language Barriers: When English isn’t the patient’s or family’s first language, professional medical interpreters are essential. Family members, especially children, should not be asked to interpret complex medical information. The emotional burden of translating life-and-death conversations is too great, and essential details might be lost or misunderstood.
Professional interpreters understand medical terminology and can ensure that cultural nuances are respected while still conveying accurate information. They’re trained to remain neutral and to translate exactly what’s being said, not what they think should be said.
Addressing Different Cultural Perspectives: Different cultures have varying beliefs about death, dying, and medical decision-making. Some cultures emphasize family decision-making over individual autonomy, while others prioritize the patient’s individual choices. Some cultures view discussing death as harmful, while others see it as necessary preparation.
Healthcare providers should ask about cultural preferences and work to accommodate them whenever possible. This might mean involving extended family in decisions, including religious leaders in conversations, or modifying the timing and setting of discussions to align with cultural values.
Ensuring Understanding of Medical Terminology: Medical language can be confusing and frightening. Healthcare providers should explain medical terms in everyday language and check frequently to ensure understanding. Don’t be embarrassed to ask for clarification—it’s better to ask questions than to make decisions based on misunderstood information.
Ask healthcare providers to explain what treatments involve and what they would feel like from the patient’s perspective. Instead of just hearing that someone would be “intubated,” it’s helpful to understand that this means they wouldn’t be able to speak and would be connected to a breathing machine.
Getting Clarification When Needed: If anything about the POLST process is unclear, ask questions until you understand. This includes asking about medical procedures, legal requirements, and the implications of different choices. Healthcare providers should be willing to explain things multiple times and in various ways until everyone understands.
Don’t hesitate to ask for written materials, diagrams, or other resources that might help clarify complex information. You might also want to bring a trusted friend or family member to appointments to help listen and ask questions you might not think of.
Remember that good communication is a two-way process. Healthcare providers should explain things clearly, but patients and families must also be honest about what they understand and what they need clarified. Working together, these communication challenges can be overcome, leading to POLST decisions that truly reflect the patient’s values and wishes.
Once your POLST form is completed, the real work begins: making sure it serves its purpose when you need it most. A perfectly completed POLST form is only valuable if the right people can find it and understand your wishes when critical decisions need to be made.
Your POLST form is a powerful tool, but only if it’s accessible to the people who need it. Think of your POLST as a communication bridge between you and everyone involved in your care, ensuring your voice is heard even when you can’t speak for yourself.
Who Needs Copies of Your POLST: Several key people and organizations should have current copies of your POLST form. Your primary care doctor, as do any specialists involved in your care, needs a copy of your medical record. If you’re receiving hospice or palliative care services, those teams also need copies.
Your designated healthcare agent should have a copy and know exactly where to find the original. Other close family members should know that you have a POLST and where it’s located, even if they don’t need their own copies. If you live in a care facility, such as an assisted living or a nursing home, they must have a current copy in your file.
Remember your pharmacy if you receive regular medications, and consider giving a copy to your attorney if they handle other legal documents for you. The goal is to ensure that anyone who might be involved in your medical care knows about your POLST and can access it quickly.
Ensuring Emergency Responders Can Access It: When emergency medical technicians (EMTs) and paramedics arrive at your home, they need to be able to find your POLST immediately. Place the original POLST form in a visible location where they will look first—typically on your refrigerator, bedside table, or in a clearly marked envelope by your front door.
Many communities have programs that help emergency responders locate crucial medical information. Some areas use special magnets or stickers that signal to EMTs that medical information is available. Check with your local fire department or emergency services to see what programs are available in your area.
If you travel frequently or spend time in multiple locations, consider keeping copies of your POLST in each place where you might need emergency care. Your POLST only works if responders can find it and read it.
Communicating Your Decisions to Family and Caregivers: Having a POLST form isn’t enough—you need to talk with your family and caregivers about what your choices mean. Don’t assume that people will understand your decisions just by reading the form. Take time to explain why you made certain choices and how those choices reflect your values.
Help your family understand what to expect in different situations. If you’ve chosen comfort measures only, explain what that means for emergency situations, hospital visits, and day-to-day care. The more your family understands your reasoning, the better they can support your decisions when difficult situations arise.
Updating Healthcare Providers About Your Wishes: Every time you see a healthcare provider—whether it’s your regular doctor, a specialist, or someone new—make sure they know you have a POLST and understand your wishes. Don’t assume that information has been shared between providers or that everyone has access to the same records.
Bring a copy of your POLST to medical appointments and ask providers to review it with you. This ensures they understand your choices and gives you an opportunity to ask questions or clarify anything that might have changed since your last visit.
Your POLST isn’t a “set it and forget it” document. Your health, circumstances, and even your values may change over time, and your POLST should evolve to reflect those changes.
When to Reconsider Your POLST Choices: Several situations should prompt you to review and possibly update your POLST form. Any significant change in your health condition is a good reason to reconsider your choices. This includes new diagnoses, changes in your prognosis, or improvements in your condition that might affect your goals of care.
Major life events can also influence your POLST decisions. Changes in your family situation, the death of your designated healthcare agent, or shifts in your personal values might all warrant updates to your form. If you find yourself thinking “I wouldn’t want that anymore” about any of your POLST choices, it’s time for a review.
How Changing Health Conditions Affect Decisions: As your health changes, your priorities and goals might shift as well. Someone who initially chose full treatments might decide that comfort care better aligns with their values as their condition progresses. Conversely, someone who chose comfort measures might decide they want more aggressive treatment if new options become available.
These changes in perspective are completely normal and acceptable. Your POLST should reflect your current wishes based on your current situation, not decisions you made months or years ago under different circumstances.
Quarterly Review Recommendations: Many experts recommend reviewing your POLST form every three months, especially if you have a serious illness that might change quickly. This doesn’t mean you need to change anything—it just means taking time to consider whether your current choices still align with your values and goals.
During these reviews, ask yourself: “Do these choices still feel right to me?” and “Have any of my circumstances changed in ways that might affect my decisions?” Regular review helps ensure that your POLST remains current and meaningful even if nothing changes.
Updating Contact Information and Decision-Makers: Don’t forget to update practical information on your POLST form. If your healthcare agent moves, changes phone numbers, or cannot serve in that role, you’ll need to complete a new POLST form with updated information.
The same applies to your own contact information and that of your healthcare providers. Outdated contact information can create dangerous delays when people are trying to reach your healthcare agent or understand your medical history during an emergency.
The ultimate goal of POLST planning isn’t just to complete paperwork—it’s to create peace of mind for you and your loved ones by ensuring your values and wishes will be honored throughout your healthcare journey.
How Proper POLST Planning Reduces Family Stress: When families face medical crises without clear guidance about their loved one’s wishes, the stress and conflict can be overwhelming. Family members may disagree about what their loved one would want, leading to arguments during already difficult times.
A well-planned POLST eliminates much of this uncertainty. When everyone knows what you would want, family members can focus on supporting each other rather than debating medical decisions. Your healthcare agent can make decisions with confidence, knowing they’re honoring your clearly expressed wishes.
The Comfort of Knowing Your Wishes Will Be Honored: There’s profound peace in knowing that your voice will be heard even when you can’t speak for yourself. A properly completed and shared POLST form ensures that your values guide your medical care, regardless of what medical situations you might face.
This peace of mind extends beyond medical decisions. Knowing that your family won’t have to guess what you would want can reduce anxiety about the future and allow you to focus on living well in the present.
Supporting Others Through Their POLST Journey: Your experience with POLST planning can help others navigate their own difficult decisions. Share what you’ve learned with friends and family members who might be facing similar situations. Sometimes the most valuable support you can offer is simply letting others know that POLST planning, while difficult, is manageable and worthwhile.
Consider sharing your story with others who are just beginning the POLST process. Your insights about what worked well and what was challenging can help them feel less alone and more prepared for their own conversations.
Living with Dignity Through Thoughtful Planning: Perhaps most importantly, POLST planning allows you to maintain control and dignity even in the face of serious illness. By making thoughtful decisions about your care while you’re able to do so, you ensure that your final chapter reflects your values and priorities.
This isn’t about controlling every detail of what happens to you—that’s impossible. It’s about controlling what you can control: who speaks for you, what kinds of treatments align with your values, and how your care team understands you as a person.
Living with a completed POLST means living with the confidence that comes from thoughtful preparation. You’ve worked hard to explore your values, make difficult decisions, and communicate your wishes clearly. Now you can focus on what matters most to you, knowing that your healthcare will honor who you are and what you value, no matter what the future holds.
Remember that POLST planning is an act of love—love for yourself, love for your family, and love for the healthcare providers who will care for you. By taking the time to plan thoughtfully, you’re giving everyone involved the gift of clarity, reducing stress during difficult times, and ensuring that your final healthcare decisions truly reflect the person you are.
The journey through POLST planning is ultimately about protecting what still helps while letting love guide every decision. When families understand that starting with “D”—the decision-maker—transforms everything that follows, they discover that advance care planning isn’t about giving up hope. It’s about ensuring that love, rather than fear or confusion, leads the way through one of life’s most challenging passages.
The revolutionary approach of beginning with Section D—choosing your healthcare decision-maker—changes the entire conversation from medical procedures to human relationships. Instead of starting with frightening questions about CPR or feeding tubes, you begin by identifying the person who knows your heart, understands your values, and will fight for what matters most to you.
When you start with “D,” every other section of the POLST form becomes a conversation about how to honor the values and relationships you’ve already identified as most important. Section C about nutrition isn’t just about feeding tubes—it becomes a discussion about how to show love and provide comfort. Section B about medical interventions isn’t just about treatments—it becomes a conversation about what kinds of care align with your definition of living well. Section A about CPR isn’t just about medical procedures—it becomes a decision about how you want to meet death, with medical trauma or with peace and dignity.
This approach recognizes that good medical decisions flow from good relationships and clear values. When healthcare providers understand who you are as a person and what matters most to you, they can provide care that truly serves your goals rather than simply following medical protocols.
One of the most harmful misconceptions about POLST planning is that it represents “giving up” or “losing hope.” The truth is exactly the opposite: advance care planning is one of the most protective things you can do for yourself and your family.
POLST planning protects you from receiving medical treatments that don’t align with your values. It protects you from having strangers make decisions about your body without understanding who you are as a person. It protects your family from the anguish of guessing what you would want during medical crises when emotions are running high and time is running short.
Most importantly, POLST planning protects your relationships with the people you love most. When your wishes are clear, family members can focus on loving and supporting each other rather than arguing about medical decisions. Your healthcare agent can make difficult choices with confidence, knowing they’re honoring your clearly expressed values rather than imposing their own preferences.
This protection extends beyond medical decisions. A well-planned POLST protects your dignity, your autonomy, and your ability to have your life’s values reflected in your final healthcare experiences. It ensures that the medical care you receive tells the story of who you are, not just what’s wrong with your body.
Perhaps the most profound aspect of POLST planning is ensuring that your voice continues to be heard even when you can no longer speak for yourself. Your voice includes not just your medical preferences but also your fears, hopes, definition of a life worth living, and understanding of what it means to die with dignity.
When you complete a POLST form thoughtfully, with attention to your values and careful selection of your healthcare agent, you’re essentially leaving a piece of yourself with the people who will care for you. Your healthcare team doesn’t just see a patient with a medical condition—they see a person with a story, relationships, and values that matter.
This voice becomes especially powerful during medical crises when decisions need to be made quickly. Instead of healthcare providers making generic decisions based on medical protocols, they can make personalized decisions based on their understanding of what you would want. Your voice guides every choice, ensuring that your care reflects who you are rather than who someone else thinks you should be.
Your voice also provides comfort to your family members during difficult times. When they know they’re honoring your wishes rather than making their own difficult choices, they can find peace even in the midst of grief and loss.
At its heart, POLST planning is an expression of love in its purest form. It’s love for yourself—ensuring that your final healthcare experiences honor your values and dignity. It’s love for your family—sparing them from impossible decisions and family conflicts during already difficult times. It’s love for your healthcare providers—giving them the guidance they need to provide care that truly serves your goals.
When love leads the conversation, the focus shifts from fear of death to celebration of life and values. Instead of dwelling on what you’re losing, you focus on protecting what still matters most to you. Instead of arguing about medical procedures, you talk about what makes life meaningful and how to ensure that meaning continues to guide your care.
Love-led conversations acknowledge that death is a natural part of life, not a medical failure. They recognize that sometimes the most loving choice is to focus on comfort rather than cure, on peace rather than prolonged treatment, on connection rather than medical intervention.
This doesn’t mean giving up hope—it means expanding your definition of hope. Hope for more good days with family, freedom from pain and suffering, a death that reflects your life’s values, and that your family will find peace and healing after you’re gone.
The POLST process, when approached with love and thoughtfulness, becomes a final gift you give to everyone who cares about you. It’s a gift of clarity in the midst of confusion, peace during chaos, and love in loss.
By starting with “D,” focusing on values rather than procedures, and letting love guide every decision, POLST planning transforms from a frightening medical task into a meaningful expression of who you are and what matters most to you. It ensures that your final chapter tells the story of a life lived with intention, relationships honored with care, and values protected until the very end.
This is the true power of thoughtful POLST planning: not just ensuring that your medical wishes are followed, but ensuring that your life’s love continues to guide and protect everyone you care about, even when you can no longer be there to do it yourself.
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