Designed to improve the quality of care people receive at theend-of-life, the OregonPhysician Orders for Life-Sustaining Treatment(POLST) Program isbased on effective communication of patient wishes, documentation of medicalorders on a brightly colored form and promise by a health care professional tohonor these wishes.

Deleteparagraph under photo:  Physician Ordersfor Life-Sustaining Treatment Paradigm The POLST ParadigmInitiative began in Oregon in 1991. Medical ethics leaders recognized thatpatient wishes for life-sustaining treatments were not being honoredconsistently despite the availability of advance directives. The Center forEthics in Health Care at Oregon Health &Science University convenedrepresentatives from stakeholder health care organizations to develop theMedical Treatment Coversheet;portable medical orders based on a patient'svalues for life-sustaining treatments.

Dr. Tolle with Patient



In 1991, it was not uncommonfor ill Oregonians nearing the end of life to receive unwanted medicaltreatment. To address this problem, The Center for Ethics convened a group ofhealth care professionals including emergency medical services (EMS), medicine,nursing, hospice, and long-term care. Over a two-year period, the newly formedTask Force developed the Medical Treatment Coversheet (MTC);designed to helphealth care professionals honor the treatment preferences of theirpatients. 

After initial evaluation and a name change to “Physician Orders for Life-Sustaining Treatment” (POLST) the form was released for use in Oregon in 1995. Using a “train-the-trainer” model, members of the task force initially educated health care professionals about use of the form. Ongoing education, research and a statewide experience-based continuous quality improvement process helped the task force improve the content of the POLST form and the process of implementation.

As Oregon’s program evolved, selected regulations rather than legislation were used to help with implementation. Other developing programs like West Virginia and New York sought legislation to facilitate POLST paradigm adoption. Each new program found that their approach needed to be thoughtfully tailored to state laws and regulations.

To learn more, visit the Oregon POLST Program web site.