DNR Orders vs. POLST Forms

Living wills and health care powers of attorney (POAs)—often combined into documents called advance health care directives—are essential documents for anyone who wants to put their health care wishes in writing. However, these health care directives may not be immediately available in an emergency. You may also want to consider supplementing your health care directives with two types of orders that are meant to be more easily apparent in emergencies: a Do Not Resuscitate (DNR) order and a Physician Order for Life-Sustaining Treatment (POLST) form. This article discusses both documents and their similarities and differences.

DNR Orders

A DNR order tells emergency medical personnel that you do not wish to be administered cardiopulmonary resuscitation (CPR). DNR orders are used both in hospitals and in situations where a person might require emergency care outside of the hospital. In some states, DNR orders go by a different name, such as "Comfort One." In other states, if you are using the document outside of a hospital or other health care facility, the document may simply be called a "DNR form." Here, we use "DNR order" because that is the most common name for the document.

You may want to consider a DNR order if you:

• have a terminal illness
• are at significant risk for cardiac or respiratory arrest, or
• have strong feelings against the use of CPR under any circumstances.

In most states, any adult may secure a DNR order.

Because emergency response teams must act quickly in a medical crisis, they often do not have the time to determine whether you have a valid health care directive or living will explaining treatments you want provided or withheld. If they do not know your wishes, they must provide you with all possible life-saving measures. But if emergency care providers see that you have a valid DNR order—which is often made apparent by an easily identifiable bracelet, anklet or necklace—they will not administer CPR.

If you ask to have CPR withheld, you will not be given:

• chest compression
• electric shock treatments to the chest
• tubes placed in the airway to assist breathing
• artificial ventilation, or
• cardiac drugs.

If you want a DNR order, or if you would like to find out more about DNR orders, talk with a doctor. In most states, a doctor's signature is required to make the DNR valid—he or she will often need to obtain and complete the necessary paperwork. If the doctor does not have the form or other information you need, call the Health Department for your state and ask to speak with someone in the Division of Emergency Medical Services.

POLST Forms

Nearly all states now offer another form that is similar to a DNR order, but differs in a few important ways. The form is most often called Physician Orders for Life-Sustaining Treatment (POLST), though some states use other names, such as Physician Orders for Scope of Treatment (POST), Clinician Orders for Life-Sustaining Treatment (COLST), Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders for Scope of Treatment (MOST), or Transportable Physician Orders for Patient Preferences (TPOPP). To find out more about POLST forms in your state, refer to this POLST state chart.

Like a DNR order, a POLST form tells emergency medical personnel and other medical providers whether or not to administer cardiopulmonary resuscitation (CPR) in case of emergency. Unlike a DNR order, a POLST form includes directions about several other life-sustaining measures as well—such as intubation, antibiotic use, and feeding tubes. The POLST form helps to ensure that medical providers will understand your wishes at a glance, but it is not a substitute for a thorough and properly prepared health care directive or living will.

A POLST form lives in your medical records and travels with you when you move between health facilities. It is often prepared to ensure that different health care facilities and service providers (including EMS personnel) understand a patient's wishes. In most states, a POLST form is printed on brightly colored paper (such as pink or green) so it will easily stand out in a patient's medical records. In contrast, a DNR order is best kept near you—and accompanied by a bracelet or other wearable that informs emergency personnel that your DNR exists.

In most states, a POLST form may be used in addition to—or instead of—a DNR order.

To be valid, the POLST form must be signed by a doctor or other approved health care professional. When you enter a hospital, hospice, or other health care facility, a member of the staff may ask whether you want to complete a POLST form. If not, you can ask for one.

To learn more about POLST forms, see About Physician Orders for Life-Sustaining Treatment (POLST) Forms.

What to Do After Making a DNR Order or POLST Form

If you obtain a DNR order or make a POLST form, discuss your decision with your family or other caretakers. If you are keeping a DNR form at home, be sure that your loved ones or caretakers know where it is. Even if you are wearing identification, such as a DNR bracelet or necklace, keep your form in an obvious place. You might consider keeping it by your bedside, on the front of your refrigerator, in your wallet or in your suitcase if you are traveling. If your form is not apparent and immediately available, or if it has been altered in any way, CPR will most likely be performed.

Learn more about Health Care Directives and Getting Your Affairs in Order.