Marion handed me the bright pink POLST form. (The Physician Order for Life Sustaining Treatment [POLST] form is used in California. Most states have a version of portable medical orders.) I was doing a home assessment for her eligibility to participate in outpatient palliative care, and had asked her if she had completed a POLST. The bright pink form was tacked to the refrigerator as recommended so paramedics could find it in an emergency. She was obviously very proud that when I asked about it she was able to readily produce it.

“Here you go.” Marion handed it to me.

“Great.”


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Her daughter Sheila sat beside her, quiet throughout most of my visit. But as her mother handed me the form, Sheila sat up straight.

“Just so you know, I’m her designated decision maker.”

I nodded, acknowledging the significance of her being chosen, then refocused my attention on Marion.

“Do you have any additional questions about this form?”

“No, Sheila knows what to do.”

Sheila piped in quickly, “I’ll make the right decisions for you, Mom.”

Consider the following sentence, which appears above the signature line on the POLST form:

“I am aware that this form is voluntary. By signing this form, the legally recognized decisionmaker acknowledges that this request regarding resuscitative measures is consistent with the known desires of, and with the best interest of, the individual who is the subject of the form.”1

Within this form the term decision maker is used. Yet how do we know if the phrase is understood correctly? How many people pay attention to or read this line above their signature?