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3030 78th Avenue SE
Mercer Island, WA 98040
Phone: 206.275.7607
Fax: 206.275.7970
Email: mi_fire@mercergov.. . .
Hours: 8:00am to 8:00pm, Daily
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City of Mercer Island / Fire Department / Medical Information & Injury Prevention / Physician Orders for Life-Sustaining Treatment

Physician Orders for Life-Sustaining Treatment

In Washington State individuals have the right, by law, to experience a natural death supported by humane comfort, and absent specific medical intervention and efforts by medically trained personnel.

In 1992 the Washington State Legislature ammended the Washington State Natural Death act to, "adopt guidelines and protocols for how emergency medical personnel shall respond when summoned to the site of an injury or illness for the treatment of a person who has signed a written directive or durable power of attorney requesting that he or she not receive futile emergency medical treatment." (RCW 43.70).

Recently the State of Washington created new documentation. It is known as the POLST form. It is intended for any adult, eighteen years of age or older, with serious health conditions, or who may expect to receive health care.

If you have a serious health condition, you need to make decisions about life-sustaining treatment. Your physician can use the POLST form to represent your wishes as clear and specific medical orders.

Your physician may use the POLST form to write orders that indicate what types of life-sustaining treatment you want or do not want at the end of life.

The POLST form asks for information about:

  • your preferences for resuscitation
  • medical conditions
  • the use of antibiotics
  • artificially administered fluids and nutrition

The POLSTform is voluntary and is intended to:

  • help you and your physician discuss and develop plans to reflect your wishes;
  • assist physicians, nurses, health care facilities and emergency personnel in honoring your wishes for life-sustaining treatment;
  • direct appropriate treatment by Emergency Medical Services personnel

Does the POLST form need to be signed?

Yes. A physician must sign the bright green form in order for it to be a physician order that is understood and followed by other health care professionals.

If I have a POLST form do I need an Advanced Health Care Directive too?

If you have a signed POLST form, it is recommended that you also have an advanced health care directive, though it is not required. You may obtain more inforamtion about advanced directives from your physician.

What if my loved one can no longer communicate his/her wishes for care?

If you are the designated health care representative, you can speak on behalf of your loved one. A physician can complete the POLST form based on your understanding of your loved one's wishes.

In what setting is the POLST form used?

The completed POLST form is a physician order form that will remain with you if you are transported between care settings, regardless of whether you are in a hospital, at home or in a long-term facility.

Where is the POLST form kept?

If you live at home you should keep the original bright green POLST form in a prominent location (e.g., on the front of the refrigerator, on the back of the bedroom door, on a bedside table, or in a medicine cabinet). If you reside in a long-term facility, your POLST form may be kept in your medical chart along with other medical orders.

How do I obtain a copy of the POLST form?

From your physician, from this website, from Mercer Island's Headquarters Fire Station, or if your physician is not yet aware of, or needs more information about POLST form, they can contact Graham Short at the Washington State Medical Association at (206) 441-9762 or

Additional information can be obtained from the following website:

Washington State Department of Health.

The Mercer Island Fire Division personnel are trained in the protocols of this State Law. Please feel free to contact with any questions you may have regarding this State Law.


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