These two terms get used interchangeably — but they're not the same document, they're not created the same way, and they don't work the same way in a medical emergency. Understanding the difference matters for anyone doing end-of-life planning.
What a Living Will Is
A living will is a legal document that records your wishes about medical treatment if you become unable to make decisions for yourself — due to incapacity from illness, injury, or cognitive decline. It speaks broadly to scenarios that may develop over time:
- Terminal illness with no reasonable chance of recovery
- Permanent unconsciousness or persistent vegetative state
- End-stage conditions where death is expected
It may address: artificial nutrition and hydration (feeding tube), mechanical ventilation (breathing machine), dialysis, CPR, antibiotics, hospitalization vs. comfort care, and other life-sustaining treatments.
A living will is written and signed by you (with witnesses and often notarization, per your state's requirements). It guides your healthcare proxy and medical team in making decisions that reflect your values — but it is not a physician order.
What a DNR Is
A DNR (Do Not Resuscitate) is a physician's order — not a document you write yourself. It instructs healthcare providers not to perform CPR (chest compressions, electric shock, breathing tubes) if your heart stops or you stop breathing.
Key distinction: a DNR is a medical order signed by a physician. It is entered into your medical record in a hospital and can be placed in your home in a visible location for EMS.
A living will may express your wish not to be resuscitated, but until a physician translates that into a physician's order (a DNR), EMS responders and hospital staff cannot act on it in an emergency.
Why This Distinction Matters in an Emergency
Imagine you're at home with a serious illness. You have a living will that says you don't want CPR. Your heart stops. Someone calls 911.
The paramedics arrive and begin CPR. They have no legal authority to stop CPR based on a living will document alone. They cannot take time to review and verify documents in an emergency — they act on visible, recognized medical orders.
If you want CPR withheld in this scenario, you need an out-of-hospital DNR or a POLST form — a physician-signed order — posted visibly in your home (often recommended on the refrigerator).
The POLST Form: A Broader Emergency Order
POLST (Physician Orders for Life-Sustaining Treatment) is an evolution beyond the simple DNR. It's a single medical order form covering multiple end-of-life preferences:
- CPR: Attempt CPR or DNR
- Medical interventions: Full treatment, limited treatment (comfort-focused with selected interventions), or comfort measures only
- Artificial nutrition: Long-term feeding tube, trial period, no artificial nutrition
Like a DNR, a POLST is signed by a physician and is an active medical order that EMS and hospital staff can act on immediately. Unlike a DNR, it covers multiple types of decisions rather than just CPR.
POLST is known by different names in different states: MOLST (Medical Orders for Life-Sustaining Treatment) in New York, MOST (Medical Orders for Scope of Treatment) in some other states. Check your state's name and form.
POLST is typically intended for people with serious illness, advanced age, or end-stage conditions — people for whom these decisions may arise in the near term. It is not typically used for healthy people planning ahead (for whom an advance directive/living will is the appropriate document).
Which Documents Do You Need?
| Situation | Documents Recommended |
|---|---|
| Healthy adult planning ahead | Living will + healthcare proxy (advance directive) |
| Serious or terminal illness | Living will + healthcare proxy + POLST (or DNR) |
| Elderly person in care facility | Living will + healthcare proxy + POLST on file |
| Person who wants no CPR at home | Out-of-hospital DNR or POLST, posted visibly in home |
How to Get a DNR or POLST
Unlike a living will, you cannot create a DNR or POLST yourself. You need to:
- Talk with your physician about your wishes
- Your physician reviews your situation and discusses the implications of DNR/POLST choices
- Your physician signs the order
- For an out-of-hospital DNR: post it visibly in your home, keep a copy in your medical records, and consider a medical alert bracelet
- For a hospital POLST: it will be entered in your medical record
Living Will vs. DNR — Summary
- A living will is created by you; a DNR is created by your physician
- A living will guides long-term care decisions; a DNR is acted on immediately in an emergency
- A living will may say you don't want CPR; it doesn't automatically become a DNR
- Most healthy adults need an advance directive (living will + healthcare proxy); most people with serious illness also need a POLST or DNR