A living will and a Do Not Resuscitate order address related but distinct questions about end-of-life care, and conflating them creates a dangerous planning gap. A living will is a legal document you create in advance, while you are healthy, to record your treatment preferences. A DNR is a medical order, signed by a physician, that instructs healthcare personnel not to perform CPR in a specific clinical situation. One is a planning document. The other is an active clinical order. Having a living will that states you do not want CPR does not mean a DNR is in place. The difference matters when emergency personnel arrive.
What a living will does
A living will records your instructions about medical treatment in circumstances where you cannot communicate them yourself. Most living wills address end-of-life scenarios: terminal illness, persistent vegetative state, and similar defined conditions. Within those situations, the document specifies which life-sustaining interventions you do or do not want, including mechanical ventilation, artificial nutrition, dialysis, and CPR.
A living will is created by you, without physician involvement, and takes effect as a legal document upon proper execution. Witnesses or notarization are required depending on the state, but no physician signature is needed. The document governs treatment decisions in the healthcare settings it is presented to, primarily hospitals and other care facilities that have a copy of it in your medical record.
The critical limitation: a living will operates within the healthcare system. It is a document that healthcare providers read and follow when making treatment decisions for a patient who is incapacitated. It does not function as a standing clinical order for emergency personnel who respond to a 911 call.
What a DNR order does
A Do Not Resuscitate order (DNR) is a physician's order instructing healthcare personnel not to perform cardiopulmonary resuscitation if the patient's heart stops or they stop breathing. Unlike a living will, a DNR requires a physician's signature. It is a medical order, not a legal document created unilaterally by the patient.
DNR orders exist in two contexts that operate differently. A hospital DNR is an order entered into a patient's chart during a hospitalization, directing that CPR not be attempted if the patient codes. It governs the staff and personnel within that facility during that admission. It does not follow the patient home or to another facility.
An out-of-hospital DNR (called an OOH-DNR in Texas, a POLST or similar form in other states) is a portable medical order that travels with the patient and applies outside of hospital settings: at home, in a nursing home, in an assisted living facility, and in an ambulance. Emergency medical services personnel are legally required to honor a valid portable DNR they encounter. Without one, EMS will typically attempt resuscitation regardless of what any other document says, because their protocols require intervention absent a specific order not to.
The gap between a living will and a DNR
The gap between these two documents is where planning failures most commonly occur. A person who has a living will stating they do not want CPR has documented that preference. But if 911 is called and EMS arrives, they will not have time to locate and read a living will. Their default protocol is to resuscitate. The living will, sitting in a home safe or a hospital chart from a prior admission, does not stop them.
This gap matters most for people who are seriously ill, elderly, or who have made a clear decision that they do not want aggressive resuscitation at end of life. For those people, a living will that says no CPR is not enough. A portable out-of-hospital DNR or POLST, signed by a physician and kept in an accessible location, is what gives that preference operational force outside of a hospital.
The gap also matters in the opposite direction. Someone who has a hospital DNR during an admission but is then discharged without a portable order is in a gray zone. If they are resuscitated at home or in a nursing home, no portable order was in place to prevent it. Ensuring that a portable order is created and kept with the patient at discharge is part of complete discharge planning for seriously ill patients.
POLST: the portable order form used in most states
Most states use a form called a POLST (Physician Orders for Life-Sustaining Treatment) or a similar portable medical order form as the standard vehicle for out-of-hospital resuscitation preferences. POLST forms go 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 states, and OOH-DNR in Texas, among others. The National POLST Paradigm organization maintains a registry of state forms.
A POLST is broader than a DNR. In addition to addressing CPR, it typically covers other life-sustaining interventions: whether the patient wants hospitalization if their condition worsens, whether they want full treatment, comfort-focused treatment only, or something in between. It is signed by both the patient (or their legal representative) and a physician, and it is printed on a distinctive, often brightly colored form so that EMS and other care providers can identify it quickly.
A POLST is most appropriate for people who are seriously ill, frail, or elderly and for whom end-of-life decisions are clinically relevant in the near term. It is not typically appropriate for healthy adults of any age. The process of creating a POLST involves a conversation with a physician about goals of care, which is part of its value: it translates those conversations into actionable clinical orders.
When you need a living will, a DNR, or both
A living will alone is appropriate for healthy adults of any age who want to document their end-of-life preferences for future use. The living will serves as the foundational document that records your wishes, informs your healthcare agent, and governs treatment decisions within healthcare facilities where it is on file. Most adults creating a basic estate plan need a living will and do not currently need a POLST or DNR.
A POLST or out-of-hospital DNR is appropriate when end-of-life care decisions are clinically relevant now: serious illness with a limited prognosis, advanced age with frailty and declining health, or a clear patient decision that aggressive resuscitation is not wanted in any setting. The POLST translates the preferences documented in a living will into actionable orders that apply everywhere.
Most seriously ill patients benefit from both: a living will that documents the full scope of their end-of-life preferences and values, and a POLST or portable DNR that translates the most critical preference (resuscitation) into a portable clinical order. The living will provides context and guidance. The POLST provides operational effect outside of hospitals.
Creating a living will as part of a complete estate plan is the right starting point for most adults. Quicken WillMaker & Trust by Nolo generates state-specific living will documents alongside a will, living trust, and power of attorney as part of a complete estate plan package. For people who need a POLST or portable DNR in addition to their living will, that conversation happens with a physician who can sign the order.
State variations worth knowing
California uses an Advance Health Care Directive as the combined living will and healthcare agent designation document. For portable resuscitation orders, California uses the POLST form, which must be signed by both the patient and a physician. California's POLST is printed on a distinctive pink form and is required to be honored by EMS, hospitals, and other care providers statewide.
Texas uses the Directive to Physicians as the living will document and a separate Out-of-Hospital DNR (OOH-DNR) as the portable resuscitation order. Texas EMS personnel are legally required to honor a valid OOH-DNR. The OOH-DNR must be signed by the patient or their legal representative and by the patient's attending physician, and it must be kept accessible. Texas also uses a POLST-equivalent form called the Texas MOST (Medical Orders for Scope of Treatment) in some care settings.
Florida uses a separate Living Will as the patient's advance directive for treatment preferences. Florida's portable resuscitation order is the Do Not Resuscitate Order (DNRO), which must be on a specific state-approved form, signed by both the patient and a physician, and kept with the patient. Florida EMS honors valid DNROs but will not act on a living will alone.
New York uses the Health Care Proxy for agent designation and informal written documents for living will purposes. New York's portable resuscitation order form is the MOLST (Medical Orders for Life-Sustaining Treatment), which applies in both inpatient and out-of-hospital settings and covers a broader range of treatment decisions beyond CPR alone.
Illinois uses the Illinois Living Will Declaration as the living will document and a Do Not Resuscitate Advance Directive (DNR-AD) as the portable order, which must be signed by both the patient and a physician to be valid outside of hospital settings.
A real-world example
Eleanor, 79, has a living will stating she does not want CPR or mechanical ventilation if she is in a terminal condition. Her living will is on file with her primary care physician and at the hospital she was admitted to last year. When Eleanor falls at home and becomes unresponsive, her daughter calls 911. The EMS team arrives and begins resuscitation. They have no portable DNR to honor. Eleanor is transported to the emergency room, stabilized, and admitted. Her living will from last year's admission is not in the current chart. Three days later, after her family locates the living will and meets with the medical team, Eleanor's wishes are honored and life-sustaining treatment is withdrawn. The family is left wondering whether all of this could have been avoided with a POLST kept on Eleanor's refrigerator, as recommended by her state's emergency services protocol.
Frequently Asked Questions
Can I create a DNR without a doctor?
No. A DNR is a physician's order and requires a physician's signature to be valid as a medical order. You can express your preference for a DNR to your physician and ask them to create one, but you cannot create the order yourself. This is the fundamental difference between a living will, which you create independently as a legal document, and a DNR, which is a clinical order that requires physician involvement. If you want a portable DNR or POLST, the process involves a conversation with your physician about your goals of care, after which they sign the appropriate form.
Does a living will automatically create a DNR?
No. A living will that states you do not want CPR documents that preference in a legal document. It does not create a physician's order. Emergency personnel responding to a 911 call are not looking for living wills and are not bound by them. Only a valid portable medical order, signed by a physician, instructs EMS not to resuscitate. For people who want their CPR preference to be followed in all settings, a living will expressing that preference is necessary but not sufficient. A portable DNR or POLST signed by a physician is what makes the preference operational outside of a hospital.
What should I do with a DNR or POLST to make sure it is followed?
Keep the original in an accessible location that EMS will check: on the refrigerator door, on a bedside table, or in a bedside drawer. Many states' EMS protocols specify that personnel should look for POLST forms in these locations. Give copies to your healthcare agent, your primary care physician, any specialists involved in your care, and any care facilities where you receive treatment. If you are admitted to a hospital, bring the portable order with you for inclusion in your chart. Some states maintain electronic registries for portable orders that EMS can access; registering your form provides an additional safeguard.
Can a family member override a DNR?
A valid DNR signed by a physician cannot be overridden by family members who disagree with it. The order reflects the patient's documented preference and the physician's clinical judgment. Family members have no legal authority to revoke a valid DNR unless they are the patient's designated legal representative, such as a healthcare agent or court-appointed guardian. A patient who has capacity can revoke their own DNR at any time by communicating that decision to their physician. For a patient who lacks capacity, revocation requires the healthcare agent or legal representative to work with the physician, and the process depends on state law and the specific clinical circumstances.
Do I need a new DNR every time I am hospitalized?
A hospital-based DNR is entered into your chart for that specific admission and does not automatically carry over to future hospitalizations. Each time you are admitted, your care team should review your advance care wishes and create a new in-hospital DNR order if appropriate. A portable out-of-hospital DNR or POLST, by contrast, remains valid across care settings until revoked by the patient or their representative. Serious or chronically ill patients who want consistent DNR status across all settings should have both: an in-hospital order entered at each admission and a portable order that applies between hospitalizations.