Navigating end-of-life medical decisions can be incredibly challenging. Understanding and completing a Washington State POLST form (Physician Orders for Life-Sustaining Treatment) is a crucial step in ensuring your wishes are respected. This comprehensive guide and free downloadable Washington State POLST form template will empower you to take control of your healthcare. We'll break down what a POLST form is, why it's vital, and how to properly complete it. My years working with legal and business templates have shown me how essential clear, accessible documents are, especially when dealing with sensitive topics like medical directives. This article aims to provide that clarity and practical help for residents of Washington State.

Understanding the Washington State POLST Form: A Vital Advance Directive

The Washington State POLST form is more than just a piece of paper; it’s a powerful tool that translates your personal medical preferences into actionable physician orders. It’s designed for individuals with serious illnesses or advanced chronic conditions, ensuring their medical team understands their wishes regarding life-sustaining treatments. Unlike a general advance directive, which often outlines broad wishes for future care, the POLST form is specifically focused on immediate medical interventions.

What is a POLST Form?

A POLST form, or Physician Orders for Life-Sustaining Treatment, is a medical document that documents a patient's wishes regarding specific medical treatments. It is completed by a healthcare professional in consultation with the patient or their designated surrogate decision-maker. The key differentiator of a POLST form is that it becomes a set of actionable medical orders that healthcare providers are legally obligated to follow. The Washington State Department of Health emphasizes that POLST forms are intended for individuals with life-limiting conditions, where an unexpected medical emergency could lead to a decision about life-sustaining treatments. It’s a consensus document, meaning it's created through discussions between the patient, their family (if desired), and their physician or other qualified healthcare practitioner.

Why is a Washington State POLST Form Important?

The importance of a Washington State POLST form cannot be overstated. It provides a clear, concise, and legally recognized method for communicating your preferences about medical interventions when you may not be able to speak for yourself.
Ensures Your Wishes Are Honored: This is the primary purpose. Whether you want aggressive treatment, comfort care, or something in between, the POLST form ensures your healthcare team knows your desires. This avoids situations where medical professionals have to guess your wishes, potentially leading to treatments you wouldn't want.
Reduces Burden on Loved Ones: Making critical medical decisions for a loved one can be emotionally devastating and confusing, especially during a crisis. A completed POLST form alleviates this burden by clearly outlining your preferences.
Facilitates Communication Among Healthcare Providers: The POLST form is a standardized document that can be easily understood by different healthcare professionals, from paramedics to hospital physicians. This ensures consistent care across various settings.
Promotes Patient Autonomy: It empowers you to maintain control over your medical care, even when your health status prevents direct communication.
Prevents Unwanted Medical Interventions: For many, the idea of being kept alive by artificial means against their will is a significant concern. The POLST form allows you to explicitly state your preferences on life support, CPR, and other interventions.

POLST vs. Advance Directive: What's the Difference?

It’s common to confuse POLST forms with Advance Directives (like a Living Will or Durable Power of Attorney for Healthcare). While both are advance care planning tools, they serve different purposes and are typically used in different contexts.
Advance Directive (Living Will, Healthcare Power of Attorney): These documents are generally for broader, future healthcare decisions. A Living Will typically describes your wishes for end-of-life care if you are terminally ill or permanently unconscious. A Durable Power of Attorney for Healthcare designates a person to make medical decisions for you if you become unable to do so. These are often completed much earlier in life and serve as a general guide. POLST Form: This is a physician order
. It’s designed for individuals with serious or advanced illnesses who are likely to be in a situation where their medical condition could deteriorate rapidly. It translates stated preferences into medical orders that are immediately actionable by healthcare professionals. The IRS.gov website, while focused on tax matters, implicitly supports the need for clear documentation in all areas of life, and medical directives are no exception in their need for clarity and compliance with legal frameworks. Think of it this way: An Advance Directive is like a blueprint for your wishes, while a POLST form is like the immediate construction orders based on that blueprint, especially relevant when construction is at a critical stage.

Downloading and Completing Your Free Washington State POLST Form Template

I understand the importance of having accessible resources. That's why I’ve made a free, downloadable Washington State POLST form template available to you. This template is designed to be user-friendly, guiding you through the essential sections.

Accessing Your Free Downloadable Template

To get your free Washington State POLST form template, simply click on the link below. We've provided this as a PDF for your convenience, allowing you to print it out and fill it in with your healthcare provider. Please Note: This template is a guide to help you gather the necessary information. The official Washington State POLST form should ideally be completed with your healthcare provider to ensure it is properly documented and understood.

Step-by-Step Guide to Completing Your WA State POLST Form

Completing the form requires careful consideration and discussion. It’s not a document to be rushed. 1. Identify Who Should Complete This Form: The POLST form is intended for individuals with a serious illness or advanced chronic condition. If you are in this category, you should discuss completing this form with your physician or other qualified healthcare practitioner. If you are unable to make these decisions for yourself, your legally authorized surrogate decision-maker should participate in the discussion and completion. 2. Sections of the Washington State POLST Form: The form is typically divided into several key sections, each addressing a specific aspect of your medical care. These sections usually correspond to specific medical interventions.
Section A: Cardiopulmonary Resuscitation (CPR)
"Attempt CPR": If your heart stops beating or you stop breathing, medical professionals should perform CPR.
"Do Not Attempt CPR": If your heart stops beating or you stop breathing, medical professionals should not perform CPR. This order is for those who would prefer not to undergo resuscitation, which can be physically invasive and may not align with their goals of care.
"Allow Natural Death": This option is often presented alongside "Do Not Attempt CPR." It means that if your breathing or heartbeat stops, no interventions should be taken to restart them, and natural death should be allowed to occur.
Section B: Medical Interventions This section addresses your preferences for other medical treatments that may be used to prolong life or manage your condition. These can include:
"Full Treatment": You wish to receive all possible medical treatments to prolong your life, including mechanical ventilation, artificial nutrition and hydration, and other interventions, even if they are burdensome.
"Selective Treatment": You wish to receive only those medical treatments that are likely to provide comfort or be beneficial, as determined by your healthcare provider. This might exclude certain invasive or burdensome treatments.
"Comfort Measures Only": You wish to focus solely on comfort and symptom management. This means that treatments aimed at prolonging life will not be pursued, and all efforts will be directed towards alleviating pain, shortness of breath, and other distressing symptoms.
Section C: Mechanical Ventilation This section addresses your wishes regarding the use of a breathing machine (ventilator).
"Try Mechanical Ventilation": You are willing to try being placed on a ventilator, with a plan for reassessment.
"Do Not Use Mechanical Ventilation": You do not want to be placed on a ventilator.
"Temporary Mechanical Ventilation Only": You are willing to use a ventilator for a short period to try to recover, but do not want long-term use.
Section D: Artificial Nutrition and Hydration This section addresses your preferences for artificial methods of providing nutrition and hydration (e.g., feeding tubes, IV fluids).
"Trial of Artificial Nutrition and Hydration": You are willing to try artificial methods.
"Do Not Use Artificial Nutrition and Hydration": You do not want these methods.
"Continue if Beneficial": You wish to receive these if they are deemed beneficial by your medical team.
Section E: Antibiotics This section addresses your preferences for antibiotics.
"Allow Antibiotics": You wish to receive antibiotics as needed.
"Withhold Antibiotics": You do not wish to receive antibiotics, particularly if they are for comfort-related reasons or if prolonging life through antibiotics is not aligned with your goals.
Section F: Other Treatments This is an open section to specify any other treatments or interventions you wish to discuss or have included in your orders. This could include dialysis, specific medications, or preferences regarding transfer to different care settings.
Section G: Patient's Condition and Goals of Care This section allows you and your healthcare provider to document your current medical condition and the overall goals of your medical care. This context is crucial for interpreting the specific orders. For example, are the goals to prolong life, improve quality of life, or manage symptoms?
Section H: Signatures and Dates This section requires the signature of the patient (if able) or their surrogate, and the signature of the healthcare practitioner who discussed and completed the form. The date of completion is also critical, as preferences can change. 3. The Importance of Discussing with Your Healthcare Provider: While you can fill out the template to gather your thoughts, it is essential to finalize the POLST form with a qualified healthcare practitioner. This ensures:
Medical Accuracy: The healthcare provider can explain the implications of each choice from a medical standpoint.
Legal Validity: The form will be completed in accordance with Washington State laws, making it a legally binding physician order.
Clear Understanding: The healthcare provider can ensure you fully understand each option and that your choices reflect your true wishes. 4. Documenting Your Wishes: Once completed with your healthcare provider, ensure you have copies of the signed POLST form. Give copies to:
Your primary care physician.
Any specialists you see.
Your designated healthcare agent.
Keep a copy with your important personal documents.
Consider carrying a wallet card that indicates you have a POLST form and its location.

Navigating Specific Scenarios with Your Washington State POLST Form

Understanding how the POLST form applies in different situations can provide further clarity.

Scenario 1: The Patient Desires Comfort Above All Else

For an individual with a terminal illness who prioritizes comfort and quality of life over prolonging life, the POLST form would reflect this:
CPR: "Do Not Attempt CPR" and "Allow Natural Death."
Medical Interventions: "Comfort Measures Only."
Mechanical Ventilation: "Do Not Use Mechanical Ventilation."
Artificial Nutrition and Hydration: "Do Not Use Artificial Nutrition and Hydration."
Antibiotics: "Withhold Antibiotics," particularly if they would only serve to prolong the dying process. The goal here is to manage pain, ease symptoms, and allow the natural progression of the illness without aggressive life-prolonging interventions.

Scenario 2: The Patient Wishes to Pursue All Possible Treatments

For someone with a treatable, albeit serious, condition who wants to explore every avenue to recovery:
CPR: "Attempt CPR."
Medical Interventions: "Full Treatment."
Mechanical Ventilation: "Try Mechanical Ventilation" or "Full Treatment" depending on the specific situation and likelihood of recovery.
Artificial Nutrition and Hydration: "Full Treatment" or "Continue if Beneficial."
Antibiotics: "Allow Antibiotics." The emphasis here is on aggressive medical intervention to fight the illness and maximize the chances of survival and recovery.

Scenario 3: A Balanced Approach to Care

Many individuals seek a middle ground, wanting to benefit from treatments but avoid overly burdensome interventions.
CPR: This can vary. Some may wish for CPR in certain circumstances but not others.
Medical Interventions: "Selective Treatment." This is where the discussion with the healthcare provider is crucial. What constitutes "beneficial"? What treatments are considered "burdensome"?
Mechanical Ventilation: Perhaps "Temporary Mechanical Ventilation Only," with a clear understanding of when it would be discontinued.
Artificial Nutrition and Hydration: "Continue if Beneficial," with specific guidelines.
Antibiotics: "Allow Antibiotics" for acute infections but perhaps not for conditions that are part of the underlying chronic illness progression. This approach requires nuanced discussions and clear documentation of what "selective" or "beneficial" means to the patient and their provider.

Legal and Ethical Considerations for Washington State POLST Forms

Understanding the legal standing and ethical implications of your POLST form is paramount.

Legal Framework in Washington State

Washington State has laws that govern advance directives and physician orders. The POLST program is designed to align with these legal frameworks, ensuring that your wishes are not only respected but legally enforceable. The Washington State Department of Health provides official guidance and resources on POLST. You can find additional information and the official form on their website. The principles of patient autonomy and informed consent are central to the legal validity of a POLST form.

The Role of the Healthcare Practitioner

The healthcare practitioner plays a critical role in the POLST process. They are responsible for:
Initiating the Conversation: Proactively discussing POLST with eligible patients.
Educating the Patient: Clearly explaining the options and their implications.
Ensuring Comprehension: Confirming the patient (or surrogate) understands what they are agreeing to.
Documenting Accurately: Completing the form precisely as per the patient's wishes and medical reality.
Following the Orders: Adhering to the physician orders documented on the POLST form.

Ethical Considerations and Your Responsibilities


Honesty and Clarity: Be honest with your healthcare provider about your values, beliefs, and what is truly important to you. Don't feel pressured to agree to something you're uncomfortable with.
Regular Review: Your health status and preferences can change. It's recommended to review your POLST form periodically, especially after a significant change in your health or life circumstances, and discuss any updates with your healthcare provider.
Involving Loved Ones: While the POLST is a medical order, involving your family or loved ones in the conversation can help them understand your decisions and support your wishes.

What if I Don't Have a POLST Form?

If you or a loved one becomes incapacitated and does not have a POLST form, healthcare providers will typically follow established medical protocols and may rely on a previously appointed healthcare agent (if one exists) or state law to guide decision-making. This can lead to uncertainty and decisions that may not align with the individual's actual preferences. This is precisely why having a POLST form is so important.

Frequently Asked Questions About WA State POLST Forms

Here are answers to common questions about Washington State POLST forms.

Q1: Who is eligible for a POLST form?

A POLST form is intended for individuals of any age who have a serious illness or advanced chronic condition, and for whom the possibility of sudden deterioration is a concern. This includes conditions like advanced cancer, heart failure, lung disease, dementia, stroke, or any other life-limiting illness.

Q2: Can I change my mind after completing a POLST form?

Yes, absolutely. A POLST form is a dynamic document. If your medical condition changes, your values evolve, or your preferences shift, you can request a review and update of your POLST form by discussing it with your healthcare provider.

Q3: What if I am not diagnosed with a "serious illness"? Do I still need a POLST?

If you do not have a serious or advanced chronic condition where a sudden medical event could lead to a need for life-sustaining treatment decisions, a POLST form may not be necessary at this time. A general advance directive (like a Living Will or Healthcare Power of Attorney) might be more appropriate for future planning. However, if you are concerned about medical interventions during any emergency, discuss it with your doctor.

Q4: Can a POLST form be completed by anyone?

No. In Washington State, the POLST form must be completed by a healthcare practitioner in consultation with the patient or their legally authorized surrogate decision-maker. This practitioner can be a physician, nurse practitioner, physician assistant, or other authorized healthcare professional.

Q5: Where should I keep my completed POLST form?

Keep your original signed POLST form in a safe and accessible place. Provide copies to your physician, your healthcare agent, and other key family members. Many people also keep a wallet card indicating they have a POLST form and where it is located.

Q6: Does the POLST form replace my Healthcare Power of Attorney?

No, they are complementary. A Healthcare Power of Attorney designates a person to make decisions for you. A POLST form provides specific medical orders based on your preferences for life-sustaining treatments. Ideally, you should have both.

Conclusion: Taking Control of Your Healthcare Future

Completing a Washington State POLST form is an act of profound self-care and responsibility. It ensures that your voice is heard, your values are respected, and your loved ones are spared the agonizing burden of making critical decisions during a crisis. By downloading and utilizing the free Washington State POLST form template provided here, you are taking a significant step towards ensuring your end-of-life medical care aligns with your deepest wishes. Remember to engage in open and honest conversations with your healthcare provider to finalize this vital document. Disclaimer: This article and the provided template are for informational and educational purposes only. They are not a substitute for professional legal or medical advice. Laws and regulations can change, and individual circumstances vary. You should consult with a qualified healthcare professional or attorney to discuss your specific situation and ensure compliance with all applicable laws and your personal needs. By acting now, you can gain peace of mind, knowing that your healthcare wishes are clearly documented and will be honored.