POLST Signature Requirements: Responding With Compassion While Ensuring Informed Consent

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The majority of states require the signature of a surrogate decision maker on a POLST form for a patient who lacks decisional capacity. While commendable in its intention to ensure informed consent, in some cases this may lead the surrogate to feel that they are signing their loved one’s “death warrant,” adding to their emotional and spiritual distress. In this paper we argue that such a signature should be recommended rather than required, as it is neither a sufficient nor necessary condition of informed consent. Additional steps—such as requiring the attestation and documentation of the signing health care professional that verbal consent was fully informed and voluntary—can achieve the ultimate goal of respecting patient autonomy without adding to the surrogate’s burden.

Original languageEnglish (US)
Pages (from-to)428-431
Number of pages4
JournalAmerican Journal of Hospice and Palliative Medicine
Issue number5
StatePublished - May 2021


  • Recommending—but not mandating—surrogate signature on a POLST form ensures informed consent while sparing surrogates undue burden
  • advance care planning
  • autonomy
  • signature
  • surrogate

ASJC Scopus subject areas

  • Medicine(all)


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