POLST vs DNR: What Is the Difference, and Do You Need One?

A DNR order and a POLST form are both medical orders signed by a health care professional. The difference is scope. A DNR (do not resuscitate) order covers one decision: do not attempt CPR if your heart or breathing stops. A POLST covers more. It says whether you want CPR, what level of treatment you want in an emergency, and your choices about tube feeding. It is meant for people who are seriously ill or frail, and it travels with you between home, ambulance, hospital and care home.

If you are healthy, you probably need neither. You need an advance directive: a living will and a named health care decision-maker. If you or someone you love is seriously ill or frail, ask the doctor about a POLST, or a DNR if CPR is the only question.

This page explains each one, who signs it, where it works and how to get one. It is general information, not medical or legal advice. Every decision here belongs in a conversation with your own doctor.

Why do these forms exist?

National POLST, the group that supports POLST programmes across the US, gives this example. At 91, Ruth is very frail and spends most of her time in bed. She and her daughter decide to complete a POLST form. It records that she wants a natural death at home. She does not want to be taken to hospital, or given a feeding tube if she stops eating (National POLST).

Without that form, what happens if Ruth collapses at home? Her daughter calls 911. The paramedics arrive. They do not know Ruth, and they cannot read her mind. So they do what they are trained to do.

When emergency teams have no clear instructions, National POLST says, they "must try everything possible to keep the patient alive," such as CPR, a breathing tube or a rush to intensive care. For most people, that is exactly right. But for people already near the end of life, it says, resuscitation attempts "can be unbearably painful, traumatic, and very often ineffective."

A living will in a drawer does not stop that. Paramedics cannot act on it. They can act on a medical order. That is why DNR and POLST forms exist.

What is a DNR order?

A do not resuscitate (DNR) order tells medical staff not to attempt CPR or other life-support measures if your heartbeat and breathing stop. The US National Institute on Aging explains the main types (NIA):

• In-hospital DNR. It becomes part of your medical chart in a hospital or nursing home. It is sometimes called a do not attempt resuscitation order, or an "allow natural death" order.
• Out-of-hospital DNR. It tells emergency medical teams your wishes if you are not in a hospital, for example at home.

Related orders cover single treatments:

• Do not intubate (DNI): no breathing machine.
• Do not hospitalize (DNH): for nursing home residents who prefer not to be sent to hospital at the end of life.

The NIA adds an important point. Even if your living will says you do not want CPR, a DNR order in your file still helps. "Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart," the NIA says.

A DNR is about CPR only. It does not mean "do not treat." You still get every other kind of care, such as pain relief, antibiotics and comfort.

What is a POLST form?

A POLST is a portable medical order for people with a progressing serious illness or frailty due to ageing (National POLST). POLST used to stand for "physician orders for life-sustaining treatment." Today, National POLST says it simply means portable medical orders.

A POLST form records three main decisions (National POLST):

1. CPR or no CPR, if your heart or breathing stops.
2. Level of treatment: full or intensive treatment, selective treatment, or comfort-focused care. Comfort-focused care puts relief of pain, breathlessness and anxiety first, and avoids hospital transfers unless comfort cannot be kept at home.
3. Medically assisted nutrition: no tube feeding, a trial period, or a long-term feeding tube.

A POLST does not only say no. It can also confirm that you do want everything done. In one National POLST example, Tom, 75, has just been diagnosed with early dementia. He chooses full treatment and CPR for now, knowing he can change the form later.

POLST vs DNR: what is the difference?

	DNR order	POLST form
What it covers	CPR only	CPR, level of treatment, tube feeding and goals of care
Who it is for	Anyone, after talking with their doctor	People who are seriously ill or have advanced frailty
Who signs it	A doctor or other authorised professional	Your health care provider, and in most states you or your representative too
Where it works	In-hospital DNR: in that facility. Out-of-hospital DNR: for emergency teams	Across settings: home, ambulance, hospital, care home
Can it say "do everything"?	No, it only limits CPR	Yes
Names a decision-maker?	No	No
Also called	DNAR, AND (allow natural death)	MOLST, POST, MOST, LST and others, by state

National POLST says that most states, and the National POLST Form, require both the provider and the patient (or their representative) to sign (National POLST FAQs).

How are these different from an advance directive?

This is where many people get confused. An advance directive is a legal document. A DNR or POLST is a medical order.

National POLST puts the differences clearly (National POLST):

• Who should have it? An advance directive: all adults. A POLST: anyone who is seriously ill or frail.
• Who fills it in? An advance directive: you. A POLST: your health care professional, after talking with you.
• Does it name your decision-maker? An advance directive: yes. A POLST: no.
• Can emergency teams use it? An advance directive: no. A POLST: yes.

So they are partners, not rivals. "For seriously ill patients, it's best to have both an advance directive and a POLST form, and confirm that they are aligned," National POLST says.

To make an advance directive, read how to write a living will and how to choose a health care proxy. Our guide to the difference between an advance directive and a living will explains the document types. If you are choosing a form, see Five Wishes vs a living will.

Do you need a POLST, a DNR, or neither?

Here is a simple way to think about it. Your doctor will guide the real decision.

• You are healthy: you need an advance directive, not a POLST. National POLST says, "If you are healthy, an advance directive is appropriate." Some states do not allow providers to sign a POLST for healthy people.
• You have a serious illness or are becoming frail: ask your doctor about a POLST. It covers more than CPR and travels with you.
• CPR is the only thing you want to decide, or your state does not use POLST in your setting: ask about a DNR, and an out-of-hospital DNR if you live at home.
• You are caring for a parent who is seriously ill: ask their doctor whether a POLST conversation is due. Our guide on talking to ageing parents about their wishes can help you start.

How do you get a POLST or DNR?

1. Book a conversation with the doctor or nurse practitioner who knows the person's health best. In the US, the NIA says advance care planning is covered by Medicare as part of the annual wellness visit.
2. Talk about the illness first. What is likely to happen? What would CPR or intensive care really mean for this person? National POLST says a POLST should never be completed without this talk.
3. Talk about goals. What matters most? Time, comfort, being at home, a family event?
4. The provider completes the form. National POLST says patients should not fill in a POLST alone.
5. Sign it, where your state requires.

Where should you keep it?

A medical order only helps if it can be found fast. National POLST suggests (National POLST FAQs):

• At home: on the fridge or in the medicine cabinet. Emergency teams look there.
• Travelling: a copy in your wallet or bag, near your ID.
• In a care home or hospital: in your chart. You take the original with you if you move.
• Tell your family you have one, so they can point paramedics to it.

National POLST says faxed and photocopied POLST forms are valid in almost all states. Some states also have electronic registries or bracelets.

You can change or cancel a POLST at any time. Review it whenever health changes.

What about the UK and other countries?

These forms have different names outside the US.

In the UK, a recommendation not to attempt CPR is called a DNACPR. Many areas now use a wider plan called ReSPECT, the Recommended Summary Plan for Emergency Care and Treatment (Resuscitation Council UK). It records CPR and other emergency treatment recommendations, after a conversation with you and your family. You keep a copy.

Resuscitation Council UK is clear that DNACPR and ReSPECT plans are clinical recommendations, "not legally binding." A DNACPR applies only to CPR, and all other care continues (Resuscitation Council UK). If you want a legally binding refusal of CPR in England and Wales, the tool is an advance decision to refuse treatment under the Mental Capacity Act 2005. In some parts of Scotland, a DNACPR form may still be needed alongside ReSPECT.

In Canada, Australia and elsewhere, your doctor or local health service will have its own forms. Ask about "advance care planning" and emergency treatment plans.

What should you do this week?

If you are healthy, make your advance directive and name your decision-maker. That covers you for now.

If someone you love is seriously ill or frail, ask their doctor one question at the next visit: "Should we talk about a POLST?"

Either way, write down what matters most first. The Complete Planning Library includes a My Wishes Worksheet for exactly this: your values, fears and care wishes, in plain words, before you meet the doctor. It is not a medical order and does not replace one. It helps you walk into that conversation knowing what you want to say.

Our free end-of-life readiness check takes a few minutes. It shows which of these papers you still need.

The honest lesson

Nobody wants to fill in a form about CPR. It feels like giving up. It is not. A POLST can just as easily say "do everything." What it really does is make sure the choice is yours, not a stranger's in a hurry.

Death is part of every life. Deciding how you want to be cared for near the end is not inviting it. It is making sure that, when the time comes, the people around you can give you the care you actually wanted.