POLST and Advance Care Planning in New Mexico

Your mother has an advance directive on file — she signed it three years ago. Then she collapses at home and the paramedics arrive. They ask for a POLST/MOST form. You hand them the advance directive. They shake their heads: "We need a POLST/MOST — this doesn't tell us what to do right now."

Advance directives and POLST-type/MOST forms overlap but serve different functions in New Mexico's medical system, and understanding the difference can determine what happens in the first minutes of a medical emergency.

What a POLST Form Is

POLST stands for Provider Orders for Life-Sustaining Treatment (some states call it MOLST or POST). New Mexico's current state form is the Medical Orders for Scope of Treatment (MOST), a POLST-type standardized medical order and state advance healthcare directive. It is signed by an authorized healthcare provider, including a physician, and translates a patient's treatment preferences into actionable medical orders that emergency responders can follow immediately.

A POLST form typically addresses:

• Cardiopulmonary resuscitation (CPR): Attempt resuscitation or allow natural death (DNR)
• Medical interventions: Full treatment, selective treatment (IV fluids and medications but no intubation), or comfort measures only
• Artificially administered nutrition: Long-term feeding tube use, trial period, or no artificial nutrition

Because it is an actionable medical order, it is designed to give emergency responders immediately actionable treatment instructions; it does not replace the broader advance-directive and healthcare-agent framework.

How POLST Differs From an Advance Directive

An Advance Health-Care Directive under New Mexico's Uniform Health-Care Decisions Act (NMSA 1978 §§ 24-7A-1 to 24-7A-18) is a legal document that does two things: it names a healthcare agent (someone authorized to make medical decisions when the parent loses capacity) and it records the parent's general treatment preferences (living will provisions).

The key differences:

An advance directive without a POLST/MOST may leave a gap: if your parent is found unresponsive at home, the advance directive may not be immediately available to EMS. A POLST/MOST or other immediately available DNR/order is designed to communicate emergency instructions at the scene; the advance directive may be in a safe deposit box, in an attorney's office, or in the hospital's electronic records.

When Your Parent Needs a POLST

A POLST form is appropriate when a patient:

• Has a serious, life-limiting illness (advanced cancer, end-stage heart failure, late-stage dementia)
• Is likely to need emergency medical services in the near future
• Has clear treatment preferences that should be honored immediately by first responders
• Resides in a nursing facility or assisted living community and has treatment preferences that should be readily available to the care team

A POLST/MOST is not intended for healthy adults doing routine advance planning. For those individuals, an advance directive is the right document.

How to Get a POLST in New Mexico

The POLST/MOST conversation happens between the patient (or their healthcare agent, after the statutory capacity determination) and the treating physician. The physician reviews the patient's medical condition, discusses treatment options, and completes the form based on the patient's expressed wishes.

The form must be signed by an authorized healthcare provider, including a physician. The patient (or their authorized representative) also signs to confirm the conversation occurred. The completed POLST/MOST should be:

• Kept in a visible location at the patient's residence (the refrigerator door is the standard recommendation for EMS access)
• Filed in the patient's medical record at their primary care clinic
• Sent with the patient during any hospital or facility transfer
• Updated whenever the patient's condition or treatment preferences change — a POLST is not a permanent order

The Relationship Between POLST and Legal Authority

If your parent still has capacity, they direct the POLST conversation themselves. No power of attorney or guardianship is needed — the patient speaks directly with their physician.

If your parent has lost capacity, the healthcare agent designated in their Advance Health-Care Directive can participate in the POLST/MOST conversation and authorize the form on the patient's behalf. If no advance directive exists, New Mexico's statutory surrogate hierarchy (spouse, then a significant other in a long-term relationship of common belief and ongoing care, then adult children by majority, then parents, then adult siblings, followed by an adult who meets the statutory special-care and availability criteria) determines who can act as surrogate.

If no family member is available and no legal documents exist, the treating team should follow New Mexico's applicable emergency and surrogate rules rather than assume that a physician can authorize a POLST/MOST alone.

Planning Both Documents Together

The strongest approach is to complete both an advance directive and a POLST/MOST at the same time, during a conversation with your parent's primary care physician. The advance directive handles the legal framework (who makes decisions, what values guide those decisions), and the POLST/MOST translates those values into specific medical orders for emergency situations.

The New Mexico Power of Attorney & Guardianship Kit covers the Advance Health-Care Directive, healthcare agent designation, and the relationship between advance planning documents and medical orders — so your family has a complete care planning framework, not just isolated forms.

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