Do Not Resuscitate Order California: How DNRs Work and Who Can Request One

Your parent told you years ago they never wanted to be "kept alive on machines." Now they're in declining health and you're trying to figure out how to make that wish legally binding. In California, this involves three different documents, and getting the wrong one — or skipping a step — can mean your parent's wishes are ignored in an emergency.

DNR vs. POLST vs. Advance Directive

These terms are frequently confused, but they serve different purposes and operate at different levels of authority.

Advance Health Care Directive (AHCD). A legal document signed by your parent while they have capacity, designating an agent to make medical decisions and stating their treatment preferences. It's governed by Probate Code Sections 4600–4806. An AHCD goes into effect when a physician determines your parent lacks capacity. It's essential for long-term planning, but emergency responders do not read or honor it — they follow medical orders.

Physician Orders for Life-Sustaining Treatment (POLST). A medical order printed on ultra-bright pink paper, signed by both a physician (or nurse practitioner or physician assistant) and the patient or their legal surrogate. Governed by Probate Code Sections 4780–4786. A POLST translates treatment preferences into actionable medical orders that paramedics, ER staff, and nursing home personnel follow immediately. It covers CPR, intubation, antibiotics, artificial nutrition, and hospitalization preferences.

Do Not Resuscitate (DNR) order. A specific medical directive within a POLST (or a standalone hospital order) instructing medical personnel not to perform CPR if the patient's heart stops or they stop breathing. In California, a DNR in the community setting is typically part of the POLST form. In a hospital or skilled nursing facility, a physician can write a separate DNR order in the patient's medical chart.

How to Get a DNR in California

A DNR is a physician's order, not a patient-signed document. Your parent cannot simply write "do not resuscitate" on a piece of paper and expect it to be honored.

Step 1: Have the conversation. Talk with your parent (or, if they've lost capacity, review their Advance Health Care Directive) about their wishes for end-of-life treatment.

Step 2: Request a POLST from the physician. Your parent's doctor, nurse practitioner, or physician assistant completes the POLST form during a medical appointment. Section A of the form addresses CPR — selecting "Do Not Attempt Resuscitation (DNAR)" makes the DNR official.

Step 3: Both parties sign. The medical provider signs the form, and the patient (or their legally authorized healthcare agent) signs it as well. If your parent lacks capacity, the agent designated in their AHCD can sign on their behalf.

Step 4: Keep the form accessible. The POLST must be immediately visible to emergency responders. In a home setting, post it on the refrigerator or inside the front door. In a nursing facility, it should be at the front of the medical chart. Paramedics are trained to look for the bright pink form.

What Happens Without a POLST

If 911 is called and paramedics arrive to find your parent in cardiac arrest with no POLST visible, they are legally required to begin CPR and full resuscitative measures. It doesn't matter what your parent told you verbally, what's written in their advance directive, or what you say at the scene. Without a signed medical order, emergency responders must treat.

This is the critical gap many families don't realize until it's too late: an Advance Health Care Directive alone does not prevent unwanted resuscitation in an emergency.

Who Should Have a POLST

A POLST is appropriate for patients with serious, advanced illness or frailty. It is not designed for healthy adults doing general estate planning. The form is intended for people whose physician would not be surprised if they died within one to two years.

For a relatively healthy parent who simply wants to document end-of-life preferences, an Advance Health Care Directive is the right starting point. The POLST becomes relevant when health declines to the point where emergency scenarios are realistic.

Revoking or Changing a POLST

Your parent can change their POLST at any time by requesting a new form from their physician. If they're hospitalized and want treatment despite an existing DNAR, they can tell hospital staff directly — verbal revocation is accepted in a clinical setting.

If your parent transfers between care settings (hospital to nursing home, nursing home to home), the POLST travels with them. It remains valid across all settings in California.

How This Fits With Your Parent's Other Documents

A complete end-of-life plan in California typically includes three layers:

1. Advance Health Care Directive — names the decision-maker and states broad treatment preferences (signed while capacity exists)
2. POLST — translates preferences into medical orders when serious illness makes emergency scenarios likely
3. HIPAA authorization language in the AHCD — ensures the healthcare agent can access medical records to make informed decisions

The California Power of Attorney & Guardianship Kit covers all three documents and explains how they interact, so your parent's wishes are honored whether they're at home, in a hospital, or in a nursing facility.

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