Short answer: A DNR is a medical order that tells emergency responders and other providers not to attempt CPR if your heart or breathing stops. California law requires it to be signed by you (or your legal health care decisionmaker) and by your physician, and the statute says in so many words that it “is not an advance health care directive” (Prob. Code §4780). An Advance Health Care Directive is a legal document you sign yourself that names an agent to make medical decisions for you and records your treatment wishes (Prob. Code §§4605, 4671). Most adults need the directive. A DNR comes later, if and when a specific decision about resuscitation has been made with a doctor.
People mix these up because both deal with end-of-life care, and because hospitals ask about both. They’re built differently, signed by different people, and read by different audiences. The directive speaks to your family and your doctors over weeks or months. The DNR speaks to a paramedic in the first ninety seconds.
Law verified against California Probate Code §§4605, 4617, 4658, 4670 to 4697, 4701, and 4780 to 4785, 2026. This is general information, not legal advice for your situation.
What a DNR is under California law
California calls a DNR a “request regarding resuscitative measures.” It’s a written document, signed by an individual with capacity or by a legally recognized health care decisionmaker, and signed by the individual’s physician, that directs a health care provider about resuscitative measures (Prob. Code §4780(a)(1)).
The statute recognizes a few forms of it (Prob. Code §4780(a)(2), (e)):
- The prehospital DNR form developed by the Emergency Medical Services Authority, or a substantially similar form.
- A POLST (Physician Orders for Life Sustaining Treatment), which covers resuscitation and other life-sustaining measures.
- A DNR medallion engraved with “do not resuscitate” or “DNR,” a patient identification number, and a 24-hour toll-free number, issued under an agreement with the Emergency Medical Services Authority.
A DNR works in or out of a hospital (Prob. Code §4785). A provider who honors one in good faith is protected from criminal, civil, and professional discipline (Prob. Code §4782), and absent knowledge to the contrary may presume it’s valid and unrevoked (Prob. Code §4784). That protection is why paramedics will follow a DNR on the refrigerator door without calling anyone first.
A POLST goes further than a bare DNR. A health care provider must treat you according to it (Prob. Code §4781.2(a)), and it’s completed by a provider based on your preferences and your medical condition, then signed by you or your decisionmaker and by a physician, nurse practitioner, or physician assistant acting under a physician’s supervision (Prob. Code §4780(c)). My guide to the AHCD, living will, and POLST covers the POLST in more depth.
What an Advance Health Care Directive is
An advance health care directive is either an individual health care instruction, a power of attorney for health care, or both (Prob. Code §4605). Any adult with capacity may sign one (Prob. Code §§4670, 4671). The statutory form in Probate Code §4701 has four parts:
- Part 1, power of attorney for health care. You name an agent and alternates to make health care decisions for you.
- Part 2, instructions. You record your wishes on life-prolonging treatment and pain relief.
- Part 3, organ donation.
- Part 4, primary physician. You name the doctor with primary responsibility for your care.
A “health care decision” under the statute includes choosing and firing providers, approving or refusing tests, surgery, and medication, and directing whether to provide, withhold, or withdraw artificial nutrition and hydration and all other care, including CPR (Prob. Code §4617(a)). So an agent under a directive can make the resuscitation decision too. What the agent can’t do is create a DNR alone. The DNR still needs a physician’s signature (Prob. Code §4780(a)(1)).
Unless the document says otherwise, your agent’s authority starts only when you’re determined to lack capacity and stops if you recover it (Prob. Code §4682). Your primary physician makes that determination unless the directive says otherwise (Prob. Code §4658). A directive doesn’t expire with time unless it sets its own end date (Prob. Code §4686).
The differences side by side
- Who signs. A DNR needs your signature (or your decisionmaker’s) and your physician’s (Prob. Code §4780(a)(1)). A directive needs only yours, plus a notary or two qualified witnesses (Prob. Code §4673(a)).
- What it covers. A DNR covers resuscitation. A POLST adds other life-sustaining measures (Prob. Code §4780(a)(3)). A directive covers any health care decision and names who makes it (Prob. Code §§4617, 4671).
- Who reads it. A DNR is written for emergency responders and treating providers, who may rely on it without further inquiry (Prob. Code §§4782, 4784). A directive guides your agent and your medical team.
- When it’s made. A directive belongs in every adult’s plan now. A DNR usually follows a serious diagnosis and a conversation with a doctor.
| Advance Health Care Directive | DNR | |
|---|---|---|
| Who signs | You, plus a notary or two qualified witnesses | You or your decisionmaker, and your physician |
| What it covers | Any health care decision, and who makes it | Resuscitation (a POLST adds other life-sustaining measures) |
| Who reads it | Your agent and your medical team | Emergency responders and treating providers |
| When it’s made | Now, as part of every adult’s plan | Usually after a serious diagnosis and a talk with a doctor |
Do I need both, or just one?
Start with the directive. It’s the document that puts a named person in charge if you can’t speak for yourself, and it covers far more than CPR. Signing a directive doesn’t create a DNR, and a DNR doesn’t appoint anyone to decide for you. The statute treats them as separate instruments (Prob. Code §4780(a)(1)).
A DNR or POLST makes sense once you and your doctor have reached a firm decision about resuscitation, usually after a terminal diagnosis, a serious chronic illness, or at an advanced age. If you’ve lost capacity by then, your legally recognized decisionmaker can sign a POLST on your behalf (Prob. Code §4780(b)).
Every estate plan I prepare includes an Advance Health Care Directive alongside two financial powers of attorney (a statutory form and a custom-written one) and a HIPAA authorization, so the person handling your medical care and the person handling your money work from the same plan. Those documents are the core of incapacity planning in California.
How is an Advance Health Care Directive signed?
A written directive is legally sufficient if it’s dated, signed by you (or in your name by another adult in your presence and at your direction), and either acknowledged before a notary public or signed by two qualified witnesses (Prob. Code §4673(a)). Witnesses must be adults, and neither your health care provider, an employee of your provider, an operator or employee of a community care facility or residential care facility for the elderly, nor your named agent can serve (Prob. Code §4674).
If you’re a patient in a skilled nursing facility when you sign, the directive isn’t effective unless a patient advocate or ombudsman signs as a witness, either as one of the two witnesses or in addition to the notary (Prob. Code §4675(a)). An electronic directive requires notarization rather than witnesses (Prob. Code §4673(b)).
My practice is fully remote. We plan by phone and Zoom, and you sign in person before a mobile notary who comes to you, which satisfies the notary option in §4673.
Can I change or revoke either document?
Yes. You can revoke the appointment of your agent only by a signed writing or by personally telling your supervising health care provider (Prob. Code §4695(a)). You can revoke the rest of a directive at any time and in any manner that communicates your intent (Prob. Code §4695(b)). A POLST can be revoked at any time and in any manner that communicates intent to revoke (Prob. Code §4780(d)).
Divorce matters here. If you named your spouse as agent and the marriage is later dissolved or annulled, the appointment is revoked automatically (Prob. Code §4697(a)). Name alternates from the start so there’s no gap if your first choice can’t serve.
What if a doctor won’t follow my directive?
A provider may decline to follow an instruction or decision that requires medically ineffective care or care contrary to generally accepted health care standards (Prob. Code §4735). A provider who declines must promptly tell you or your agent, help transfer you to a provider willing to comply, and keep caring for you until the transfer happens, including pain relief and palliative care (Prob. Code §4736).
Where to start
If you don’t have an Advance Health Care Directive, that’s the first document to fix. See my Advance Health Care Directive page for how I prepare it as part of a full California estate plan. Talk to your doctor about a DNR or POLST when your health makes the resuscitation question real, and give your agent a copy of whatever you sign.
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