DNR vs POLST: Which End-of-Life Form Is Needed?

When it comes to end-of-life care for a loved one, few documents are as critical (or as misunderstood) as the DNR and POLST. Many families use these terms interchangeably, but confusing them can lead to heartbreaking situations where a person’s final wishes are not honored.

In a medical crisis, every second counts, and the wrong form can guide first responders toward treatments your loved one never wanted. Understanding the distinct roles of a Do-Not-Resuscitate (DNR) order and a Physician Orders for Life-Sustaining Treatment (POLST) form is not just about paperwork; it’s about providing unequivocal clarity to ensure their voice is heard when they cannot speak for themselves.

DNR vs POLST: Two Different End-of-Life Forms

If an older adult knows how they want to be treated during a health emergency, it’s essential to consider two important documents – a POLST and a DNR.

Both documents are available for free and ensure that emergency responders and hospitals respect your older adult’s wishes for end-of-life treatment.

But there are some key differences.

To help you and your care recipient choose the form that works best for them, we explain what a POLST and a DNR are, the differences between them, why they’re necessary, and where to get the forms.

What is a POLST?

POLST stands for Physician Orders for Life-Sustaining Treatment. It’s a one-page form that specifies the end-of-life treatments that someone does or doesn’t want.

It’s legally recognized in many, but not all, U.S. states and is usually printed on bright pink paper to make it easy for emergency responders to find.

A POLST is a medical order signed by a doctor, so if your older adult stops breathing or their heart stops beating, emergency responders and hospitals must follow the POLST’s instructions.

This document is usually recommended for terminally ill or very frail seniors who have made their end-of-life wishes clear.

What is a DNR?

DNR stands for Do Not Resuscitate and is a signed medical order written by a doctor.

It tells health care providers and emergency medical personnel not to do CPR on older adults if they stop breathing or if their heart stops beating.

The DNR is only a decision about CPR (cardiopulmonary resuscitation).

It doesn’t affect any other treatments, such as pain medicine, other medicines, or nutrition.

If the doctor’s orders include other end-of-life treatments, your older adult may prefer a POLST instead.

VIDEO: DNR vs POLST: What’s the Difference?

POLST vs DNR: What’s the Most Important Difference?

The primary difference between a POLST and a DNR is that a POLST covers a variety of end-of-life treatments. A DNR only gives instructions about CPR.

With a POLST, Seniors Can Specify:

• If they do or don’t want CPR
• What type of life-prolonging medical interventions would they want on top of comfort care, if any
• Under what circumstances would they want to be moved to a hospital
• If they want a feeding tube, and if so, for how long

With a DRN, Seniors Can Specify:

• Whether or not to accept CPR if incapacitated

During an emergency, decisions about other interventions or treatments (beyond CPR) would be left to emergency responders or hospitals.

Why Should Seniors Sign a POLST or a DNR Form?

Without a DNR or POLST, hospitals and EMTs are required to do their best to resuscitate someone who is not breathing or doesn’t have a heartbeat. They can’t stop these efforts without a signed medical order.

So, if an older adult doesn’t want those measures taken, they must have either a POLST or a DNR.

How to Obtain a POLST or DNR Form

After understanding your loved one’s preferences, discuss their end-of-life wishes with their doctor.

Doctors should have access to the appropriate state POLST or DNR form, and they must sign it to make it official. It’s essential to use a form that’s legally recognized in the care recipient’s state.

But no matter which forms are legally recognized, it’s important to discuss an older adult’s end-of-life preferences with their doctor. They can advise you on how to ensure those wishes will be carried out.

Make Sure the DNR is Easily Accessible and Well Known

A POLST or DNR can only be honored if people know it exists.

Notify doctors, nurses, caregivers, family members, and assisted living staff about your older adult’s wishes and that they have a signed POLST or DNR.

Make sure doctors, hospitals, and assisted living communities have the form on file and/or post it prominently in your senior’s room.

Print copies on neon colored paper for your hospital essentials kit and for family members.

At home, make sure the form is posted prominently near your older adult’s bed or on the refrigerator – EMTs are likely to look there.

How Do Consent Forms Fit with POLST and DNR?

Navigating end-of-life paperwork can feel like learning a new language. As we mentioned, while POLST (Physician Orders for Life-Sustaining Treatment) and DNR (Do Not Resuscitate) forms are often discussed together, it’s critical to understand that they are medical orders, not consent forms.

Here’s the simple breakdown:

• Consent Forms are about PERMISSION.
• POLST/DNR are about INSTRUCTIONS.

Think of it this way:

A consent form is used before a medical event to appoint a person (via a Healthcare Power of Attorney or Proxy) who has the legal authority to give future permission for treatments on your loved one’s behalf. It answers the question, “Who decides?” when your loved one cannot speak for themselves.

A POLST or DNR form is a set of immediate medical orders that tells medical professionals what to do or what not to do during a medical crisis. It answers the question, “What are the orders?”

How They Work Together: The Essential Partnership Between Concent Forms and DNR/POLST Orders

Consent forms and medical orders are not rivals; they are partners in ensuring your loved one’s wishes are honored. The consent form (the Healthcare Proxy) appoints the decision-maker, who uses their authority to help create and enforce POLST or DNR orders.

The Conversation & Consent: The process starts with your loved one discussing their wishes with you (their likely future proxy) and their doctor. By signing a Healthcare Power of Attorney, they are giving you “consent” to speak for them.

The Orders are Created: Based on those wishes, the doctor completes a POLST or DNR form. These are the specific medical orders that reflect the consent your loved one has already given.

The Proxy Enforces the Orders: In a crisis, EMTs and doctors are legally bound to follow the POLST/DNR. If a situation arises that isn’t covered by the form, they will contact the Healthcare Proxy (the person named in the consent form) to make a decision.

The Bottom Line for Caregivers

You cannot have a complete care plan with just one of these documents. The consent form (Healthcare Power of Attorney) ensures there is a trusted voice to interpret wishes in unanticipated situations. The POLST/DNR ensures there are clear, immediate orders for first responders in anticipated crises.

Having both in place is the ultimate act of advocacy, creating a seamless system that honors your loved one’s values and ensures their wishes are respected, no matter what happens.

Final Thoughts About End-of-Life Wishes

Choosing between a POLST and a DNR is a profound act of love and respect. While the conversation can be difficult, the clarity it provides is a gift to your loved one, your family, and the medical professionals who may need to act quickly.

You are not just filling out a form; you are creating a roadmap that ensures their values and choices direct their care until the very end. Have this conversation with their doctor now, while everyone is calm and can think clearly.

By doing so, you are replacing uncertainty with peace of mind and ensuring that your loved one’s dignity and autonomy are protected, no matter what the future holds.

Recommended for you:

• Honor End-of-Life Wishes With a POLST Form
• The Reality of CPR for Seniors: Get the Facts
• Simple End-of-Life Planning: The Five Wishes Living Will