POLST vs Advance Directive Oregon: Which Document You Need and When

Oregon invented the POLST form. In 1991, Oregon health systems created the nation's first Portable Orders for Life-Sustaining Treatment program, and the model has since spread to nearly every state. But many Oregonians confuse the POLST with the Advance Directive — and they serve fundamentally different purposes.

Getting the wrong one, or relying on only one, can leave gaps in your healthcare planning.

The Core Difference

An Advance Directive is a legal planning document. It appoints a healthcare representative to make medical decisions when you cannot, and records your preferences about life support and tube feeding. It is designed for all adults age 18 and older, regardless of health status.

A POLST is a medical order. It translates your treatment preferences into immediate, actionable orders that emergency responders and hospital staff must follow. It is designed specifically for people with advanced, progressive illness or extreme frailty.

Think of it this way: an Advance Directive tells your family and doctors what you want. A POLST tells the paramedic in the back of the ambulance what to do right now.

Side-by-Side Comparison

Who Needs Which Document

Every adult should have an Advance Directive. You do not need to be sick, elderly, or facing surgery. A healthy 30-year-old could be in a car accident tomorrow and need someone to make medical decisions. Without an Advance Directive, Oregon's default priority list determines who decides — and that person may not be who you would choose.

A POLST is for people with a serious medical condition. Your physician will typically recommend a POLST when:

• You have been diagnosed with a terminal illness
• You have advanced dementia or a degenerative neurological condition
• You are extremely frail with a life expectancy that may be limited
• You have been hospitalized multiple times for the same chronic condition
• You have decided to limit certain medical interventions (CPR, intubation, IV antibiotics)

If you are generally healthy, a POLST is premature and unnecessary.

How They Work Together

The Advance Directive and POLST are not alternatives — they are complementary.

Before incapacity: Your Advance Directive ensures your chosen healthcare representative has legal authority. The POLST (if applicable) ensures your specific treatment preferences are converted into standing medical orders.

During a crisis: Emergency responders look for the POLST first — it gives them immediate orders (resuscitate or not, intubate or not, transport or comfort measures only). At the hospital, your healthcare representative steps in for any decisions the POLST does not cover.

If they conflict: Oregon medical providers generally treat the POLST as the more current expression of the patient's wishes, since it is created in consultation with a physician and reflects the patient's actual medical condition. However, a healthcare representative can request changes to the POLST if they believe it no longer reflects the patient's values.

How to Execute Each in Oregon

Advance Directive:

• Use OHA Form 3905 (the official Oregon Health Authority form)
• Sign before a notary public OR two qualified adult witnesses
• Witness restrictions: neither can be your healthcare representative, attending physician, or healthcare provider; at least one must be unrelated and not entitled to inherit from your estate

POLST:

• Complete the form with your physician, nurse practitioner, or physician assistant
• The clinician signs the form (not you — the patient or representative provides verbal consent)
• The form is printed on bright green paper
• It is entered into the Oregon POLST Registry, accessible by emergency responders statewide

The Oregon POLST Registry

Oregon maintains a centralized electronic POLST Registry. When emergency responders arrive at a scene, they can access the registry to verify a patient's POLST orders even if the physical form is not present. This is a critical advantage — a paper Advance Directive in a filing cabinet at home does nothing for a paramedic at the scene.

Registration happens automatically when the clinician submits the completed POLST form.

The Oregon Power of Attorney Kit includes the complete Advance Directive alongside the financial POA and remains disposition form. For the POLST, talk to your physician — it is a clinical document that requires their involvement.

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