POLST and Medical Aid in Dying

Both POLST-Portable Medical Orders and Medical Aid in Dying (MAiD), as national initiatives, trace their origins to Portland, OR in the early 1990s. The grassroots organizations of both groups have gained traction in advancing their objectives in recent years. Yet while both initiatives seek to make changes in legislation and processes regarding the care patients receive at the end of their lives, they have fundamentally different aims. The primary difference is patient intent.

The POLST initiative seeks to help patients whose health is declining to articulate their goals of care and treatment preferences, documenting them in the form of a portable medical order set. The intent is for the patient to decide the interventions they do and do not want as they approach a natural death. Certified by a medical provider, this order set – the result of a comprehensive conversation between patients and their loved ones, led by a physician or a trained facilitator, is immediately actionable. This is especially helpful for first responders who lack the authority to act outside established protocols without a medical order. Because the POLST document is portable it moves with the patient between care settings, providing the accepting attending physicians with the information they need to write orders that are consistent with the patient’s known wishes.

MAiD initiatives also seek to amplify the patient’s voice, promoting patient autonomy at the end of life. However, they advocate for statutory changes allowing patients who have decided they no longer wish to live and intend to deliberately end their own lives to do so with medical assistance. The patient’s intent here is not just to have a say in what medical interventions are to be used but to request a particular intervention that directly results in the expedited death of the patient. Confusion regarding the two initiatives is exacerbated by MAiD’s efforts to associate their initiative with POLST as one of several “interventions” that a patient might select.

Both POLST and MAiD initiatives require physician action. The difference between them is that in MAiD the action requested is that the physician perform an intervention with the intention of ending the life of the patient. With POLST the physician’s action serves only to discern the patient’s treatment preferences and goals of care. The treatment preferences, however, do not include an option for MAiD or an expectation that the physician will participate in such an act.

National POLST has published a statement outlining in more detail the fundamental differences between their organization and MAiD initiatives. You will find a link to it here:

https://polst.org/wp-content/uploads/2021/02/2021.01.28-Distinguishing-POLST-from-MAID-Policy.pdf