Health Care Directives Explained: Living Wills, POLST, DNR

A health care directive tells your doctors and your family what kind of care you want if you're ever unable to speak for yourself. The documents covered here each do a slightly different job. Some spell out your treatment wishes ahead of time. Others name someone to make decisions on your behalf. A few combine both roles into one form. The name attached to each document can vary by state, so don't be thrown if your state calls something by a different term than you expected.

This overview reflects review by Jeff Burtka, an attorney educated at George Mason University Law School. Since these forms differ from state to state, double-check the exact rules where you live before signing anything.

In this article

• Living will
• Durable power of attorney for health care
• Advance directives
• Do-not-resuscitate (DNR) order
• POLST forms
• Health care directive terminology
• What each state calls these documents

Living will

The name is misleading. A living will has nothing to do with the will or trust that hands down your property after you die. Some states call this document a health care "declaration" instead. Whatever the label, it's where you write down which treatments you'd accept and which you'd refuse if illness or injury ever leaves you unable to speak up. You might use it to say plainly whether you want to stay on life support or be allowed to die naturally. The label shifts from state to state, but you'll always recognize it as the place where you record your specific medical wishes.

For more detail on what these two documents typically spell out, see the discussion of living wills and health care powers of attorney.

Durable power of attorney for health care

A durable power of attorney for health care lets you pick someone you trust to make medical calls for you if you lose the ability to communicate. You'll also see this document called a health care POA, medical power of attorney, or medical POA. Whoever you choose for this job is typically referred to as your agent or attorney-in-fact.

Your agent can follow through on the wishes you've already put in writing in your living will, and can also make calls on medical situations you never anticipated.

Note that this is a completely different document from a power of attorney for finances, which hands someone authority over your money and property rather than your medical treatment.

For help thinking through who to name, there's guidance elsewhere on choosing a health care agent.

Other names for a health care agent

Besides "agent" and "attorney-in-fact," you might see a health care decision-maker called a representative, proxy, patient advocate, surrogate, or a similar term. If you spot the word "guardian" or "conservator," though, that's something else entirely.

A court appoints a guardian or conservator — unlike the agent you name yourself through a health care directive. Sidestepping that court process is one of the strongest reasons to set up a directive before you need one. If you become unable to make decisions and never named an agent, your family will likely have to ask a court to appoint someone on your behalf. There's more on that process elsewhere, covering conservatorships and adult guardianship.

Advance directives

A number of states fold the living will (or declaration) and the durable power of attorney for health care into a single form, typically called an advance health care directive or just an advance directive. In those states, one document both records your treatment preferences and appoints your health care agent.

Check the state-by-state chart below to see whether your state uses this combined approach.

Do-not-resuscitate (DNR) order

A do-not-resuscitate order tells first responders you don't want CPR if your heart or breathing stops. People often add a DNR alongside their other health care documents once they're seriously ill and certain they don't want life-prolonging measures near the end.

While hospitalized, you can ask your doctor to enter a DNR into your medical chart. Outside the hospital, you can arrange what's known as a prehospital DNR, kept at home or at a care facility so it's ready if paramedics show up.

There's a fuller explanation of DNR orders elsewhere.

POLST forms

Nearly every state also has a Physician Orders for Life-Sustaining Treatment form, known as a POLST, though you might see it called a POST, MOLST, or MOST depending on where you live. Like a DNR, it captures your wishes for emergency care, but it goes further than a DNR alone. You can use it to spell out your preferences on intubation, antibiotics, and feeding tubes, not just CPR.

There's a broader overview of POLST forms elsewhere, including a state-by-state chart.

Health care directive terminology

These documents go by many names depending on where you live. Use the table below to match each term to what it actually means.

What each state calls these documents

Living wills, health care powers of attorney, and advance directives carry different names in different states. The table below shows what your state calls each one. As always, verify current requirements against your state's official forms or with a local attorney.