A living will, a DNR, and a POLST can all communicate important information about medical care. That does not make them interchangeable.
One can describe wishes for future medical treatment. Another addresses whether CPR should be attempted if a person’s heart stops or they stop breathing. The third turns current treatment decisions into medical orders for someone who is seriously ill or frail.
Understanding those differences matters because having one document does not necessarily mean the others exist, apply, or say the same thing.
What Is a Living Will?
A living will is a type of advance directive. It allows you to document your wishes about medical treatment in case you cannot communicate those decisions yourself.
The American Academy of Family Physicians explains that an advance directive can describe the treatment someone would want depending on how serious their medical condition is, including if they have an illness they are unlikely to recover from or are permanently unconscious.
A living will is created in advance. You do not need to be seriously ill to have one. In fact, advance directives can be useful precisely because an accident, illness, or loss of decision-making capacity can occur unexpectedly.
The requirements for living wills and other advance directives vary by state, so the exact form and when its provisions apply can differ.
A living will is also not the same thing as a medical order. It documents your instructions and preferences for future circumstances. That distinction becomes particularly important when comparing it with a DNR or POLST.
What Does a DNR Address?
A do-not-resuscitate order, commonly called a DNR, addresses a much narrower medical decision.
According to the American Academy of Family Physicians, a DNR tells healthcare providers not to perform cardiopulmonary resuscitation, or CPR, if a person’s heart stops or the person stops breathing.
That is a significant decision, but it is also a specific one.
A DNR does not by itself describe every type of medical treatment someone would or would not want. Its focus is resuscitation. A living will can address broader treatment preferences that become relevant under the circumstances described in the document.
This is one reason the terms should not be used as though they mean the same thing.
Someone can have a living will without having a DNR order. AAFP specifically notes that a DNR does not have to be part of a living will or another advance directive. A person can discuss a DNR with a physician separately, and the physician can place the order in the medical record.
Having an advance directive, therefore, should not automatically be interpreted to mean that someone does not want CPR.
Where Does POLST Fit In?
POLST serves another purpose.
POLST is part of advance care planning for people who are seriously ill or have advanced frailty. Rather than simply recording wishes for an unknown future situation, a POLST form turns current treatment decisions into portable medical orders.
The American Academy of Family Physicians describes POLST as a form completed with a physician for someone who has been diagnosed with a serious illness. Importantly, AAFP also states that a POLST does not replace other advance directives.
The National POLST Collaborative makes a similar distinction. It describes POLST as a portable medical order designed for people with serious illness or advanced frailty. Depending on the form, the orders can address CPR as well as other decisions, such as hospitalization, intensive care, or the use of a breathing machine.
That makes POLST different from both a living will and a DNR.
A living will plans for future circumstances. A DNR focuses specifically on CPR. POLST can contain immediately actionable medical orders based on a person’s current medical condition and goals of care.
POLST programs also have different names in different states. A person might encounter terms such as MOLST, POST, or MOST instead. The specific form and requirements depend on the state.
Why a POLST Does Not Replace a Living Will
The difference is easier to understand when you consider who these documents are designed for.
An adult can create an advance directive while healthy. The document helps prepare for future situations in which that person cannot communicate medical decisions.
POLST is generally intended for someone whose present health makes specific medical decisions more immediate. A healthcare professional completes the form after discussing the person’s condition, treatment options, and goals of care.
The documents can therefore work together rather than compete with one another.
An advance directive can provide broader information about someone’s wishes and, depending on the document, identify a healthcare agent who can make decisions when necessary. A POLST provides medical professionals with specific orders appropriate to the person’s current condition.
Having a POLST does not eliminate the value of an advance directive. Having an advance directive also does not mean someone automatically needs a POLST.
A DNR and POLST Are Not the Same Either
A DNR and POLST can overlap, but they are not the same thing.
The simplest way to think about the difference is that a DNR answers one question: Should healthcare providers attempt CPR if the person’s heart stops or they stop breathing?
A POLST can answer that question and others about the person’s current medical care.
For example, a person might have a DNR that says not to attempt CPR if their heart stops. A POLST could include that same instruction and also contain medical orders about other treatment the person would want while they are still alive, such as whether they should be transferred to a hospital or receive certain life-sustaining treatments. The exact options depend on the state’s form.
So a DNR can be one part of the medical instructions reflected on a POLST. The POLST itself covers more than the decision about CPR.
That is why the two terms should not be used interchangeably.
Know Which Document You Actually Have
The names can sound similar because living wills, DNR orders, and POLST forms can all become relevant when someone cannot communicate during a medical crisis. Their roles, however, are different.
A living will records instructions for future healthcare circumstances. A DNR addresses whether CPR should be performed if breathing or heartbeat stops. POLST translates treatment decisions for a seriously ill or frail person into medical orders that can follow that person across care settings.
One document should not be assumed to stand in for another.
It is also worth reviewing healthcare documents when health circumstances or treatment preferences change. Your healthcare agent and the professionals involved in your care should know which documents exist and where current copies can be found.
The terminology matters because the documents do different jobs. Knowing what you have, and what it actually says, can make your wishes clearer when those instructions need to be understood and followed.
Sources
American Academy of Family Physicians, “Advance Directives and Do Not Resuscitate (DNR) Orders,” Read the full article here.
National POLST Collaborative, “Frequently Asked Questions About POLST,” Read the full article here.