What Is a DNR and How Is It Different from a POLST?
By CRYSTAL BAI •
The short answer: A DNR (Do Not Resuscitate) order instructs medical providers not to perform CPR if a patient's heart stops or they stop breathing. A POLST (Physician Orders for Life-Sustaining Treatment) is a broader medical order that covers CPR preferences alongside other treatment decisions — ventilation, hospitalization, feeding tubes — in a single portable document signed by a physician. DNR is one choice within POLST, but POLST covers much more.
What Is a DNR?
A Do Not Resuscitate order is a specific medical order instructing healthcare providers not to initiate cardiopulmonary resuscitation (CPR) — chest compressions, electric shocks, and breathing tubes — if the patient's heart stops or they stop breathing. It does NOT mean "do not treat" — it applies only to resuscitation.
A DNR must be signed by a physician to be valid in a hospital or other medical setting. In most states, a separate Out-of-Hospital DNR form is required for EMS to honor the order outside a hospital.
What Is a POLST?
POLST (Physician Orders for Life-Sustaining Treatment) is a portable medical order — signed by a physician and the patient — that travels with the patient across care settings. It documents preferences for:
- CPR — attempt resuscitation or do not attempt
- Medical interventions — comfort measures only, limited interventions, or full treatment
- Artificially administered nutrition — long-term tube feeding, trial period, or no feeding tube
POLST is specifically designed for people with serious illness or advanced age — not for healthy people. It carries the weight of a physician's medical order, which means EMS can legally honor it.
Key Differences
| Feature | DNR | POLST |
|---|---|---|
| Scope | CPR only | CPR + other treatments |
| Form type | Medical order | Medical order |
| Signed by | Physician | Physician + patient/surrogate |
| Portability | Varies (typically hospital-based) | Designed to travel across settings |
| EMS validity | Only with specific out-of-hospital form | Yes (designed for EMS) |
| Who needs it | Hospitalized patients | Seriously ill, advanced age, or at end of life |
POLST Names Vary by State
POLST has different names in different states: MOLST (NY, MD), MOST (NM, SC), POST (TN, OK, WV), DMOST (NC), LAPST (LA), TPOPP (NY), and others. The function is the same.
What About an Advance Directive?
An advance directive (living will) is not a medical order — it's a legal document expressing preferences. Healthcare providers should use it to guide decisions, but EMS and emergency physicians respond faster to medical orders like POLST. Complete both: the advance directive for guidance, the POLST for immediate action.
Frequently Asked Questions
Can EMS honor a DNR?
Only if you have an Out-of-Hospital DNR (or equivalent) signed by a physician and present with you. A hospital DNR alone does not bind EMS. The POLST form is specifically designed to be honored by EMS across settings.
Should I get a POLST even if I'm healthy?
No — POLST is designed for people with serious, chronic, or terminal illness, or for frail elderly people. If you are generally healthy, an advance directive (living will + healthcare proxy) is the appropriate document.
Can I change my DNR or POLST?
Yes. Both can be revoked or changed at any time while you have decision-making capacity. To revoke, destroy the document and notify your medical team. A new POLST requires a new physician order.
What happens if EMS arrives and I have a POLST saying 'comfort measures only'?
EMS is legally required to honor a valid POLST in most states. They will provide comfort care (pain relief, oxygen if needed for comfort) but will not initiate CPR or aggressive intervention. Keep your POLST accessible — on the refrigerator, in a medical alert holder.
Does a death doula help with POLST completion?
Death doulas can facilitate advance care planning conversations that lead to POLST completion, and they can help families understand the difference between various documents. The actual POLST must be signed by a physician.
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