Physician orders for life-sustaining treatment and emergency medicine: ethical considerations, legal issues, and emerging trends

Ann Emerg Med. 2014 Aug;64(2):140-4. doi: 10.1016/j.annemergmed.2014.03.014. Epub 2014 Apr 16.


Since its original development in Oregon in 1993, Physician Orders for Life-Sustaining Treatment (POLST) is quickly growing in popularity and prevalence as a method of communicating the end-of-life care preferences for the seriously ill and frail nationwide. Early evidence has suggested significant advantages over advance directives and do-not-resuscitate/do-not-intubate documents both in accuracy and penetration within relevant populations. POLST also may contribute to the quality of end-of-life care administered. Although it was designed to be as clear as possible, unexpected challenges in the interpretation and use of POLST in the emergency department do exist. In this article, we will discuss the history, ethical considerations, legal issues, and emerging trends in the use of POLST documents as they apply to emergency medicine.

MeSH terms

  • Advance Care Planning / ethics
  • Advance Care Planning / legislation & jurisprudence
  • Emergency Medicine / ethics*
  • Emergency Medicine / legislation & jurisprudence
  • Emergency Service, Hospital / ethics
  • Emergency Service, Hospital / legislation & jurisprudence
  • Humans
  • Life Support Care / ethics*
  • Life Support Care / legislation & jurisprudence
  • Physicians / ethics*
  • Physicians / legislation & jurisprudence
  • Resuscitation Orders / ethics*
  • Resuscitation Orders / legislation & jurisprudence
  • United States