What’s the Difference Between an Advance Directive and a DNR?

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If you’re ever unable to make your own medical decisions, the paperwork you’ve set up ahead of time can be vital to making sure that your wishes and desires are followed. The many forms you could fill out may seem overwhelming (advance directive vs DNR vs POLST…), but know that establishing a plan can be as simple or as extensive as you want it to be. Here’s a cheat sheet to covering your bases.

You need an advance directive

An advance directive, also sometimes referred to as a living will, is a legal document that allows you to share your wishes for medical treatment if you’re unable to do so. Patients can specify which treatments they would want performed and which they wouldn’t, as well as when those decisions should come into play.

You can download the applicable form for your state and make it official by having the specified number of witnesses also sign the document. And with an advance directive, you’ll also be able to appoint a surrogate, or health care proxy, to make medical decisions on your behalf. That means someone who knows you—and what you would want—will be able to make nitty-gritty decisions not covered by your directive.

You might not need a POLST or MOLST

Unlike advance care directives, which anyone can (and should!) create, there are certain documents that are tailored to seriously ill patients not expected to live longer than a year. Known as either a POLST (Provider Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment), these forms summarize a patient’s wishes for medical treatment and turn those desires into medical orders. While creating an advance directive doesn’t involve a doctor, a POLST or MOLST requires a physician’s approval, which means they’re medical orders.

A POLST can work with your advance directive

Nearly all healthcare professionals recommend that patients have advance care directives, but a POLST form can translate the broad treatment wishes outlined in advance directives into specific medical orders. In addition, an advance directive allows you to appoint a surrogate where a POLST does not. So if your medical condition changes and the wishes you expressed via your POLST no longer make sense—but you’re unable to make treatment decisions yourself—your doctors can consult your health care proxy to help make those treatment decisions.

An advance directive isn’t the same as a DNR

By law, emergency medical service professionals are required to administer life-sustaining treatments like CPR to patients. But some people, typically those who are terminally ill or very frail due to advanced age, may wish to avoid resuscitation efforts. In those cases, a DNR (Do Not Resuscitate) order may be appropriate. DNRs, like POLST forms, require a physician’s sign-off and are medical orders, instructing emergency personnel to withhold resuscitation efforts.

If you don’t want to receive resuscitation, including that information in an advance care directive is not enough. You’ll have to create a DNR (with your physician’s sign-off) and keep a copy of that form on your person, to avoid receiving this care from medical staff or first responders.

One more distinction to keep in mind, as you debate a POLST, MOLST, or DNR, is that DNRs are only applicable when your heart stops beating or you stop breathing. POLST forms, however, can detail your desire to decline other life-sustaining treatments, such as intubation. It is possible to use a POLST or MOLST form in lieu of or in addition to a DNR. If you’re unsure which form is appropriate for you, start by talking to your physician: All three forms require a physician’s sign-off to become official.

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