POLST vs. DNR vs. Advance Directive
What's the difference between a POLST, a DNR and an Advance Directive? All three of them cover end-of-life medical care and outline the person's wishes regarding the way in which they die. But each one is a little different in ways that can be important.
- POLST: POLST stands for "Physician Orders for Life-Sustaining Treatment." It is usually a single-page, bright pink document that can be used in any medical facility. It must be signed by a physician, and it serves as medical orders from you to your medical providers. It outlines how you should be treated when you are declining from a terminal illness or are in the process of actively dying. It covers everything from resuscitation requirements to your preferences on intubation, surgery and antibiotics. In essence, it allows you to dictate how aggressive the care will be and whether you prefer to die in a hospital, with hospice or at home. You can learn the status of your state's POLST program, if it has one, by consulting the National POLST Paradigm website.
- DNR: A DNR is similar to a POLST, but it is much simpler. It stands for Do Not Resuscitate. Like POLST, it also must be signed by a physician. However, the only focus of the DNR is to let emergency services and medical personnel know that you do not want to be resuscitated (CPR, defibrillation, etc.) if your heart and breathing stop (cardiopulmonary arrest). This is especially important for people who have chosen to die at home so that, after they pass, emergency services are not required to perform CPR upon arrival.
- Advance Directive: The Advance Directive is similar to a POLST, but it is a legal document instead of a medical one. It does not need to be signed by a physician, but it does need to be signed in front of witnesses and notarized. An Advance Directive allows you to create a Medical Power of Attorney, or a proxy, to relay your wishes to a medical team if you are no longer able to communicate. The proxy can then make decisions for you on a case-by-case basis concerning your end-of-life care, drawing on the desires you outline in the Advance Directive.
All three documents have some overlap, but each one serves a vitally different function, and therefore it is important to obtain each one if you feel it is relevant to your end-of-life needs. Check with a lawyer and your medical provider to ensure that your documents are legally binding and up to date. While efforts have been made to standardize end-of-life documents across the U.S., be aware that laws and requirements still vary from state to state.
