POLST vs. DNR: Which Do You Need?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Most people are perplexed about having a POLST (Physician Order for Life-Sustaining Treatment) and a DNR (Do Not Resuscitate). End-of-life decisions are emotional and difficult even in the best of circumstances.

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Your health status may change or decline, or you could have a change of heart about what you want or don’t want in terms of medical interventions. Having a POLST or a DNR filed can give you choices that reflect a possible range of medical circumstances. 

Talking with your loved ones about these decisions can help you clarify the direction you want to take. Life can change quickly, and an accident or terminal illness will influence your thinking about what is most important. The first step is to make sure that you have advance directives in place for your state.

From that point forward, review those advance directives as your situation changes. Most advance directives have the option of DNR but will not have a POLST. We will walk you through the difference so you can prepare for most situations and your wishes honored. 

Overview: POLST vs DNR Forms

Using a POLST or a DNR form depends on specific conditions. A POLST form is a portable medical order for specific medical treatments and interventions that the patient would want depending on their immediate medical diagnosis or condition. POLST forms are most appropriate for individuals with a serious illness or frailty near the end of their life.

A DNR covers any accident or illness out of a hospital setting and instructs emergency personnel not to perform cardiopulmonary resuscitation if a patient's breathing stops or if the patient's heart stops beating.

                         DNR                                                          POLST

It only applies to resuscitation.

Can include full resuscitation or state do not resuscitate.

It does not include any other medical interventions.

Can be very specific about medical interventions such as intubation, a feeding tube, or any other medical treatment.

Usually used outside a hospital setting.

Used across medical settings, including senior living communities or at home.

It only takes effect when the person has no pulse, isn’t breathing, and is not responsive.

Used during a medical emergency.

It can be for medically frail individuals but also those with a terminal condition.

Used for medically frail individuals.

It does not necessarily require a doctor’s order. The process depends on the state where you live.

Requires a physician signature.

Anyone over the age of 18 can have a DNR.

A POLST form is most often for people at the end of life who are frail. 


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POLST vs. DNR: What’s Their Purpose?

You may be thinking, “why are there so many forms for deciding end-of-life care?”  The reason is that there are so many different circumstances and individual preferences. The philosophy behind advance directives, POLST, and DNR is that people have the right to determine what they want and don’t want when a life-threatening event occurs.

Without legally indicating your wishes, emergency personnel will do everything they can to resuscitate you. If you are in the hospital, healthcare workers will consult with your family, but not everyone may agree. Also, in the event you are unconscious and have a healthcare power of attorney, that person will decide for you. It is far better to make your choices known ahead of time.

The way to think about a POLST is that it is flexible. You may be going to the hospital for a dangerous procedure and want to have options about your care should things not go well. For example, a 90-year-old person with an emergency procedure who may be unlikely to recover if there is a problem may opt not to have invasive life support. Or, if a medical event leads to disability, then this same 90-year-old may not want to be kept alive with artificial respiration and tube feeding.

By contrast, a DNR is used only if emergency personnel find you unconscious with no pulse. If they know your DNR status, they will not attempt to resuscitate you. If they are not aware, they will perform CPR regardless of your condition or medical situation.

Most medically compromised or frail individuals want to have a DNR handy because the chances of meaningful recovery are small. There is the possibility of brain damage or permanent disability. However, a 30-year-old may want to be resuscitated since their likelihood of recovery and return to a reasonable level of functioning may be better. 

POLST vs. DNR: Differences

While these two forms can help you make the appropriate end-of-life decisions in the event of your incapacitation, you may not need both in order to cover your bases. What are the differences between the two?

  • A POLST may have a DNR statement in it, but it may also ask for resuscitation under certain circumstances.
  • A POLST may indicate specific medical interventions you want or don’t want including, but not limited to, artificial breathing, or a feeding tube. 
  • A POLST may state if you wish to be moved to a hospital or other healthcare setting during a medical emergency. 
  • A POLST is most often used in a hospital or different healthcare setting during a medical procedure
  • People who are frail, seriously ill, or at risk of experiencing a life-threatening event or at the end of life most often use a POLST.
  • A DNR is only to be used when you are unconscious and have no heartbeat.
  • A DNR does not have specific instructions about medical interventions like intubation or tube feeding.
  • A DNR is most often used outside a hospital setting, but you can ask for the form while you are in the hospital as well.
  • Anyone of any age can use a DNR. 
  • In some cases, a DNR is part of advance directives that don’t require a physician’s signature but do require a witness. DNR requirements vary by state.


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POLST vs. DNR: Similarities

However, as mentioned above, there are many reasons why you would want to have one of these handy as part of your end-of-life planning, no matter your age. Here are some of the things a POLST and DNR have in common:

  • Both a POLST and DNR are medical orders.
  • Both allow you to make advanced decisions with the guidance of your medical team about interventions.
  • Without a POLST or DNR, medical personnel are required to intervene to save your life.
  • Neither the POLST nor the DNR replaces advance directives
  • Both a POLST and DNR must be written and not verbalized to be valid.
  • Both a POLST and a DNR should be clearly visible where you live, and family and healthcare providers should have copies.
    • Some people have their POLST taped to their fridge or in some other conspicuous place for emergency personnel to see. 

Do You Need a POLST, DNR, or Both?

Not everyone needs a POLST form. The POLST form is for people who are considered to be at risk for a life-threatening clinical event. This means that they have a serious medical condition, including frailty and that their current health status indicates the need for medical orders for emergent or future medical care. An advance directive is an appropriate document for making future end-of-life care wishes known to loved ones for healthy people.

Assisted living and other senior living facilities strongly suggest a POLST form upon move-in. So do hospice and home health care companies, or when you are admitted to the hospital with a critical condition or in frail condition, but it is not required. If you have a POLST, you can indicate DNR on the document.

A DNR is not appropriate for a healthy person because resuscitation might save their life and return them to their previous level of functioning. Most healthy people would opt for resuscitation since the chances of having a continued quality of life are good. 

Along with a POLST and or DNR, you also need advance directives. Should you become unable to speak for yourself at any point in your lifetime, you need a trusted person to carry out your healthcare wishes.

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POLST vs. DNR: How to Make Them Legal

The process of making a POLST and DNR legal varies by state. Most states have their POLST forms printed on brightly colored paper, so they stand out and are easily recognizable.

Also, a POLST might be called something different in your state, such as Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders on Scope of Treatment (MOST), Physician's Orders on Scope of Treatment (POST), or Transportable Physician Orders for Patient Preferences (TPOPP). You can view your state’s POLST forms and requirements here

To fill out a POLST form, you will discuss it with your doctor, family, and other healthcare providers. A doctor must sign the POLST form for it to be legal.

In some states, an advance directive will have a place where you can indicate your DNR status. In other states, you may have to fill out a separate document. Most states have DNR laws however, with different requirements varying from state to state. Additionally, not all DNR orders are recognized between states. Some states will require one or more witnesses, and others will need the document to be notarized.

The best and most thorough way to ensure that you meet all of your state’s legal requirements is to meet with an elder law attorney. Simply having a DNR and or POLST is not enough. Consider a complete estate and long-range plan that includes advance directives and POLST and DNR if appropriate. You should review all legal end-of-life documents regularly since your circumstances may change over time.  

POLST vs. DNR: Which Do You Need?

As confusing and emotional as end-of-life and medical decisions are, having options is a good thing but can be overwhelming. Making good decisions involves the uncomfortable process of evaluating what is most important to you. 

You, your family, and others close to you are the first people to talk to about what you want. Your healthcare provider can be a good source of information on your prognosis and what medical interventions make sense in your particular situation.

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