Michigan’s Updated POLST Form

Many individuals have durable powers of attorney for health care, or advance directives, as part of their estate plan. These documents appoint a surrogate, or patient advocate, to make health care decisions for them when they are unable to do so in a hospital setting. An advance directive is effective only after two physicians have certified as part of the patient’s medical record that the patient is unable to participate in their own health care decision-making. As such, there are conditions to when an advance directive becomes effective. Nor is a durable power of attorney for health care in the form of a medical or physician’s order.

One additional document that some individuals who are in poor health or in a frail condition should consider executing is a portable medical order called a Portable Order for Life Sustaining Treatment, or POLST. Although the POLST may appear to be just another advance directive, Michigan’s version of the POLST, called MI-POST (Michigan Physician Orders for Scope of Treatment) takes immediate effect. Moreover, unlike a Do Not Resuscitate (DNR) order that generally only provides instructions with regard to CPR, the MI-POST covers a variety of end-of-life treatments. Accordingly, with an executed MI-POST, the individual communicates if they want, or do not want CPR, along with other treatment options, such as a Do Not Intubate (DNI) Order.

Technically, a MI-POST is a physician’s order that communicates specific medical orders for treatment when the individual cannot speak for themselves. The MI-POST is signed by the individual’s attending physician, a nurse practitioner, or a physician’s assistant in collaboration with the patient. A MI-POST is primarily used by those individuals who are afflicted with a very serious illness or who are at high risk of a life-threatening medical event or crisis. If the individual is near death, they can express their treatment and placement wishes with a completed MI-POST. If the individual’s medical condition changes or improves, their MI-POST must either be revoked or revisited. A MI-POST form tells all healthcare providers during a medical emergency what the individual wants, such as: “Take me to the hospital,” or “I want to stay here,” or “Do not attempt CPR.” Often a POLST is produced on a distinctive bright pink or green form in order to stand out among other medical records. The Michigan form has a pink boarder on its page.

A MI-POST guides medical care in light of the individual’s current medical condition. The individual’s participation is voluntary. Normally, a MI-POST is written at a hospital to follow the individual after they are discharged from the hospital with the intent that it will be honored by third-parties outside of the hospital setting, like EMS personnel. As such, a MI-POST continues to have legal effect after the individual leaves his or her physician’s immediate care. Since it is in the form of a physician’s order, a MI-POST cannot be overridden by the individual’s family members. Generally, a MI-POST form does not expire or have a ‘shelf-life’ but it should be reviewed whenever the individual: (i) is transferred from one care setting or level to another; (ii) encounters a substantial change in their health status; (iii) changes their primary care provider; or (iv) changes his or her treatment preferences or goals of care.

Recently the MI-POST form was updated to simplify its terms, eliminate confusion or the need to search other laws or other records before implementing the individual’s treatment wishes, and deal with protected health information that is not readily accessible by others. And it was shortened to be signed on one single piece of paper. The planned effective date of this new MI-POST form is January 1, 2023.

MI-POST is not part of any federal program; rather, POLSTs are developed by each state. Currently only five states have adopted a standard POLST form. There is, however, a National POLST tax-exempt organization that seeks to standardize the POLST process throughout the United States. Under most state statutes, a POLST (like a MI-POST) can replace a stand-alone “Do Not Resuscitate” order. [https//polst.org.]

The intended purpose of an executed MI-POST is to facilitate kind, humane, and compassionate service to individuals who have executed a valid MI-POST, by giving the individual with an advanced illness more control over the medical treatment that they receive. The MI-POST form can guide discussions between individuals, their families, their physician, and their entire health care team about treatment wishes in the event of a serious illness. Consider adding a MI-POST to your estate planning documents if you have serious health issues or are at an advanced age.

Legal Authority for MI-POST: Michigan Compiled Laws 333.20201