As a set of standing medical orders, the POLST approach is inflexible. Straightforwardly following orders created outside of a particular situation may be ill-advised, improper and even harmful to the patient.
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These judgments are tricky to make, because the specifics of each case differ, and those specifics change with time and disease progression. DNR’s should be put in place only when the circumstances warrant it, that is to say, on a case-by-case, patient-specific basis.
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Better than a living will, or at least together with it, we should always choose a surrogate, a living person, who will make health care decisions in real time on our behalf if we are rendered unable to do so.
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