The Difference Between a Living Will and a DNR

If you have started looking into advance care planning, you have probably encountered both terms: living will and DNR (Do Not Resuscitate). Many people assume they mean the same thing or that having one makes the other unnecessary. In reality, these are two distinct documents with different purposes, different scopes, and different legal requirements. Understanding the difference is essential for making sure your healthcare wishes are fully covered.

What is a living will?

A living will is a written legal document that spells out your preferences for medical treatment if you become unable to communicate those preferences yourself. It covers a broad range of decisions, including:

• Whether you want mechanical ventilation (a breathing machine)
• Your preferences regarding feeding tubes and artificial hydration
• Whether you want dialysis if your kidneys fail
• Your wishes about CPR (cardiopulmonary resuscitation)
• Pain management preferences, including comfort-focused care
• Organ and tissue donation wishes

A living will goes into effect only when you are incapacitated — meaning you cannot speak for yourself — and typically only when you have a terminal condition, are permanently unconscious, or are in a similar end-stage medical situation. The specific triggering conditions vary by state, which is why it is important to use a form that reflects your state’s laws.

Think of a living will as a comprehensive instruction manual for your healthcare team and family. It addresses many different scenarios and treatments, giving guidance that applies over the course of an illness or medical crisis.

What is a DNR?

A DNR — Do Not Resuscitate order — is a specific medical order that tells healthcare providers not to perform CPR if your heart stops beating or you stop breathing. That is its entire scope. It does not address ventilators, feeding tubes, dialysis, or any other treatment. It answers one question only: should CPR be attempted?

There are important distinctions in how DNR orders work:

• In-hospital DNR: This is a medical order written by your physician and placed in your hospital chart. It applies while you are a patient in a healthcare facility.
• Out-of-hospital DNR (or POLST/MOLST): Many states have portable medical orders — often called POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) — that are recognized by emergency medical services (EMS) outside of a hospital. Without a portable order, paramedics are generally required to perform CPR regardless of what your living will says.

A DNR must be signed by a physician. You cannot simply write “DNR” on a piece of paper and have it be legally valid. It is a medical order, not a personal document.

Key differences at a glance

Do you need both?

In many cases, yes. A living will and a DNR serve complementary purposes. Your living will provides the broad framework for your care preferences across many scenarios. A DNR addresses the specific, time-critical question of CPR.

Here is an important practical reality: if you collapse at home and someone calls 911, the paramedics who arrive are trained and often legally required to begin CPR immediately. They generally will not — and often cannot — take the time to read a living will document. A portable DNR form (like a POLST), displayed prominently, is what tells them not to resuscitate.

Conversely, a DNR alone does not address what happens if you are hospitalized and unable to communicate. Should you be placed on a ventilator? What about a feeding tube? These questions are outside the scope of a DNR — and a living will is where you answer them.

Common misconceptions

• “A living will is all I need.” A living will is a crucial foundation, but it may not be recognized by EMS in an emergency. If you do not want CPR in a cardiac arrest situation, talk to your doctor about a POLST or similar portable medical order.
• “A DNR means do not treat.” This is one of the most dangerous misunderstandings. A DNR only means do not perform CPR. You can have a DNR and still receive full medical treatment — antibiotics, surgery, pain management, and anything else. A DNR does not mean “do nothing.”
• “Only elderly or terminally ill people need these documents.” Anyone over 18 can benefit from a living will. Accidents, strokes, and sudden illnesses do not discriminate by age.
• “My family knows what I want.” Studies consistently show that family members incorrectly predict patient preferences about one-third of the time. Written documents remove the guesswork.

Taking the next step

Start with a living will. It is the foundation of your advance care plan and covers the widest range of decisions. Once you have created your living will, bring it to your next doctor’s appointment and discuss whether a DNR or POLST order is appropriate for your situation. Your physician can help you decide and can create the medical order if you choose.

Neither document is permanent. Both can be updated or revoked at any time, as long as you are mentally competent to make that decision. Your preferences may change as your health changes, and that is perfectly normal and expected.