DNR vs. POLST: Understanding the Difference

When planning for future medical care, it's common to hear about both Do Not Resuscitate (DNR) orders and Physician Orders for Life-Sustaining Treatment (POLST) forms. While they may seem similar, they serve different purposes and are intended for different situations.

Understanding the difference can help ensure your healthcare wishes are clearly communicated and honored when they matter most.

What Is a DNR?

A Do Not Resuscitate (DNR) order is a medical directive that applies to one specific circumstance: if your heart stops beating or you stop breathing.

A DNR instructs emergency medical personnel not to perform cardiopulmonary resuscitation (CPR). However, if you still have a pulse and are breathing, even if you're experiencing a medical emergency, a DNR does not provide instructions about other treatments or medical care.

What Is a POLST?

A Physician Orders for Life-Sustaining Treatment (POLST) form is a more comprehensive medical order. It includes your wishes about CPR, but it also provides healthcare professionals with instructions for additional treatments if you are seriously ill and unable to communicate your decisions.

A POLST may include preferences for:

• CPR and resuscitation efforts
• Intubation and mechanical ventilation
• Antibiotic treatment
• Artificial nutrition, hydration, and feeding tubes
• Levels of medical intervention, from comfort-focused care to full hospital treatment

In Pennsylvania, POLST forms are traditionally printed on bright pink paper, making them easy for emergency personnel to recognize during a medical emergency.

Key Differences Between a DNR and a POLST

Although both documents help communicate your healthcare wishes, they are designed for different purposes.

• DNR: Applies only if your heart stops beating or you stop breathing and limits CPR.
• POLST: Covers CPR while also providing instructions for additional life-sustaining treatments.
• DNR: Does not provide guidance if you still have a pulse and are breathing.
• POLST: Includes treatment preferences even if you have a pulse or are breathing but cannot speak for yourself.
• DNR: May be appropriate for anyone who chooses not to receive CPR.
• POLST: Is generally intended for individuals who are frail, elderly, or living with a serious illness.
• DNR: Is typically signed by the patient and physician.
• POLST: Is signed by the patient and a physician, physician assistant (PA), or nurse practitioner, as permitted under Pennsylvania law.

Which Document Is Right for You?

The right document depends on your health, your treatment preferences, and conversations with your healthcare provider.

If your only concern is declining CPR in the event your heart or breathing stops, a DNR may be appropriate. If you want to provide detailed instructions about treatments such as ventilators, feeding tubes, antibiotics, or the level of medical care you wish to receive, a POLST offers much broader guidance.

Planning Ahead Matters

Advance care planning allows you to make important healthcare decisions before an emergency occurs. Whether you choose a DNR, a POLST, or other advance directive documents, having the appropriate paperwork completed can provide clarity for your loved ones and your healthcare team.

If you have questions about which document is right for your situation, speak with your physician or attorney before completing any advance healthcare directive.