DNR and POLST Forms in Utah: How They Work and How They Compare to an Advance Directive

The POLST Form: A Medical Order, Not Just a Wish

POLST stands for Physician Orders for Life-Sustaining Treatment. Despite the name, a POLST form is not simply a personal statement of preference — it is an actual medical order that health care providers, including emergency medical technicians and paramedics, are legally required to follow.

A Utah POLST form covers three specific categories of medical decision:

1. CPR. The form specifies whether to attempt cardiopulmonary resuscitation (CPR) if the patient's heart stops or they stop breathing. "Do Not Attempt Resuscitation" (DNAR) is the option that most people associate with the term DNR.
2. Medical interventions. The form selects one of three levels of care: comfort measures only (focusing on symptom relief and avoiding hospitalization); limited interventions (basic medical treatments while avoiding invasive measures like intubation); or full treatment (all measures to sustain life, including mechanical ventilation and intensive care).
3. Artificial nutrition. The form states whether a feeding tube or intravenous nutrition should be offered if the patient cannot eat on their own.

Because a POLST is a standing physician's order, EMS does not need to evaluate your capacity, contact a family member, or locate a legal document before following it. When paramedics arrive and find a signed POLST form, they are obligated to act on the instructions it contains. This immediacy is the feature that makes the POLST form essential for seriously ill patients — and that distinguishes it from every other end-of-life planning document.

The DNR: One Instruction Within the POLST

A Do Not Resuscitate order — commonly abbreviated DNR, or in some contexts DNAR (Do Not Attempt Resuscitation) — is the specific instruction not to perform CPR if a patient's heart stops or they stop breathing. A DNR is narrower than a POLST: it addresses only the CPR question, while the POLST covers the full range of life-sustaining treatment decisions.

In a Utah hospital, a physician can write a DNR order in the patient's medical chart as part of inpatient care. Outside the hospital — in a home, assisted living facility, or other non-clinical setting — the mechanism for establishing a DNR is the POLST form. The POLST's first section directly addresses CPR preferences, and checking "Do Not Attempt Resuscitation" on that form is the functional equivalent of an out-of-hospital DNR order.

An Advance Health Care Directive can include language expressing a preference against resuscitation, but that language does not function as an immediately effective medical order. A POLST — because it requires a physician's or other provider's co-signature — is the document that translates a DNR preference into a binding instruction that EMS can act on without further evaluation.

Who Must Sign a POLST — and Who Cannot

Two signatures are required to create a valid Utah POLST form:

• The patient. If the patient has decision-making capacity, they sign directly. If the patient lacks capacity, their authorized representative — a health care agent named in an Advance Health Care Directive, a court-appointed guardian, or a surrogate under Utah Code Title 75A, Chapter 9 — may sign on their behalf after a conversation with the treating provider about the patient's condition and wishes.
• A licensed physician, advanced practice registered nurse (APRN), or physician assistant (PA). The provider's co-signature is what transforms the document from a personal statement into a medical order. Without it, the form has no legal authority as an order. An attorney, a family member, a notary, and a hospital chaplain — no matter how trusted — cannot substitute for the required provider signature.

This requirement has an important practical implication: a POLST cannot be created in a lawyer's office or at home without medical involvement. It is completed through a conversation with your physician or another qualified provider, typically in a clinical setting when your health condition makes the planning timely and specific.

The Advance Health Care Directive: Planning Before a Crisis

An Advance Health Care Directive (AHCD) is a legal document governed by Utah Code Title 75A, Chapter 9, the Uniform Health Care Decisions Act as adopted in Utah. It serves two related purposes: naming the person you want to make medical decisions on your behalf (your health care agent), and documenting your own health care wishes for that agent and your providers to consult.

Unlike the POLST, an AHCD does not take effect immediately upon signing. It activates when a health care professional determines that you lack the capacity to make or communicate health care decisions. Until that determination is made, you retain full authority over your own care.

What an Advance Health Care Directive Can Cover

The scope of an AHCD is broader than the three specific decisions a POLST addresses. A well-drafted directive can include:

• The name of your health care agent and one or more alternates;
• The scope of authority you grant to the agent — whether they can consent to any medical decision or only specific categories;
• Your general values and goals for care, including preferences about quality of life versus length of life;
• Specific instructions about CPR, mechanical ventilation, artificial nutrition, dialysis, and other life-sustaining treatments;
• Instructions about organ and tissue donation;
• Mental health treatment preferences;
• Preferences about dying at home versus in a facility.

These instructions inform both your agent's decisions and your providers' care — but they do not operate as standing medical orders. When your agent relies on your AHCD to consent to withholding CPR, the next step is typically for a physician to issue a formal POLST or in-patient DNR order based on that consent. The AHCD and the POLST function together rather than as substitutes for each other.

Who Must Sign an Advance Health Care Directive

Under Utah Code Title 75A, Chapter 9, a power of attorney for health care must be in a record, signed by the individual, and signed by one adult witness. The witness must reasonably believe the signing is voluntary and knowing. The following people are disqualified from serving as the witness:

• The agent named in the directive;
• The agent's spouse or cohabitant; or
• If the individual lives in or is receiving care in a nursing home or assisted living facility: any owner, operator, employee, or contractor of that facility.

The witness must be present when the individual signs, or when the individual represents that the document reflects their wishes. Under Utah's 2026 electronic execution rules, a witness participating by real-time audio/video satisfies the presence requirement. There is no two-witness option and no notary option — one witness is both the minimum and the maximum required under current Utah law.

If the AHCD contains only a health care instruction (preferences and values, but no designation of an agent), no witnessing is required at all under Utah Code § 75A-9-106. The witness requirement applies specifically to the power of attorney for health care portion.

No physician, APRN, or PA signature is required to create a valid AHCD. This is the opposite of the POLST: the AHCD is a legal document that does not require a medical professional, while the POLST is a medical order that does not require a legal professional.

An attorney is not legally required to complete an Advance Health Care Directive, but working with one is helpful. Utah provides a standard statutory form (Utah Code § 75A-9-110) that covers the most important decisions: naming a health care agent, expressing treatment preferences, addressing organ donation, and authorizing HIPAA access. The standard form is the right choice for most people. Highly customized directives can create practical problems — medical providers responding to an emergency need to find and apply your instructions quickly, and forms that deviate significantly from the standard layout are harder for staff to recognize and follow under time pressure.

POLST vs. Advance Health Care Directive: Side-by-Side Comparison

How the Two Documents Work Together

An Advance Health Care Directive and a POLST form are not competing documents — they operate in sequence and complement each other.

The AHCD establishes authority and documents values. It names the person — your health care agent — who has legal authority to speak for you when you cannot. It gives that agent the context of your wishes, values, and priorities so they can make informed decisions in situations your directive may not have specifically anticipated.

The POLST form translates current wishes into immediate action. When a patient has a POLST, emergency responders, nurses, and other providers know exactly what to do without having to locate legal documents, convene a family meeting, or consult a physician about what the patient probably would have wanted. The POLST answers the immediate question; the AHCD answers the broader one.

The two documents also interact directly. When a patient lacks capacity, the health care agent named in the AHCD has authority to consent to the creation or modification of a POLST on the patient's behalf. Without a named agent, the right to consent may fall to a surrogate identified through Utah's statutory default order — a process that can be uncertain, time-consuming, and contentious when family members disagree. Having both documents in place clarifies who speaks for the patient and what the patient's providers are authorized to do.

When You Need Each Document

Every Utah adult over 18 should have an Advance Health Care Directive. It does not require a health crisis to create — it is a planning document intended to name your agent and capture your preferences before you need them. Creating one while you are healthy and your thinking is clear is far better than trying to execute one during a hospitalization.

A POLST form is appropriate when your health condition has reached the point where specific decisions about CPR, medical interventions, and artificial nutrition are not hypothetical but near-term. Common situations that make a POLST timely include:

• A terminal diagnosis with a prognosis of months or less;
• Advanced frailty in elderly patients where hospitalization and aggressive intervention would be unlikely to restore function;
• Admission to a nursing facility or long-term care setting;
• After a serious hospitalization where the patient has formed clear preferences about future care;
• Any situation where the patient and their physician have had a substantive conversation about goals of care and want to formalize the result as a medical order.

A POLST is not a document for healthy 45-year-olds to complete as part of routine estate planning. The CPR and intervention decisions on the form are specific to a patient's current medical condition. A POLST created when someone is in good health may not reflect the right choices when that person is actually facing the situations the form addresses. The value of the POLST comes from its being current — completed in conversation with a treating provider who understands the patient's condition and prognosis.

Frequently Asked Questions

• Do I need both a POLST and an Advance Health Care Directive in Utah?+
  For most healthy adults, an Advance Health Care Directive alone is the right starting point — it names someone to make decisions if you lose capacity and documents your wishes broadly. A POLST is designed for people who are already seriously ill, frail elderly, or approaching end of life. At that stage, having both is ideal: the AHCD establishes your agent and general preferences, while the POLST translates your current wishes into a standing medical order that emergency responders can act on immediately without waiting to locate or interpret a legal document.
• Can my family override a POLST in Utah?+
  No. A properly executed POLST is a physician's medical order, not a suggestion. Health care providers — including EMS — are legally required to follow it. Family members who disagree with the instructions on a POLST cannot override it at the bedside. If you want a family member to have authority over your medical care, that person should be named as your health care agent in an Advance Health Care Directive. The agent, acting within the scope of that directive, can consent to updating a POLST if circumstances change — but they cannot unilaterally reverse an existing POLST order in an emergency.
• Who can sign a POLST form in Utah?+
  Two signatures are required on a Utah POLST form. First, the patient must sign — or, if the patient lacks capacity, their authorized representative (a health care agent under an Advance Health Care Directive, a court-appointed guardian, or a surrogate identified under Utah's Uniform Health Care Decisions Act, Utah Code Title 75A, Chapter 9). Second, a licensed physician (MD or DO), advanced practice registered nurse (APRN), or physician assistant (PA) must co-sign the form. The provider's signature is what makes the POLST a medical order rather than a personal statement of preference.
• What if EMS finds me unconscious — which document do they follow?+
  EMS in Utah will look for and follow a POLST form. Because the POLST is a standing physician's order, it is immediately actionable by paramedics and EMTs without any additional evaluation of your capacity or consultation with family members. An Advance Health Care Directive, by contrast, is a legal document — EMS does not typically have time to locate, read, and interpret it at the scene of an emergency. If you want emergency responders to withhold CPR or limit interventions, a POLST form kept in a visible location (such as on your refrigerator or with your chart) is the document that accomplishes that goal.
• Can I create a DNR without a doctor?+
  No. A Do Not Resuscitate order — whether issued as an in-hospital DNR or as part of an out-of-hospital POLST form — requires a physician, APRN, or PA to co-sign. Without that co-signature, the document is not a valid medical order and cannot be honored by EMS or hospital staff. You can express a wish not to be resuscitated in an Advance Health Care Directive without a doctor, but that directive does not take effect until you lose decision-making capacity, and EMS may not have access to it in an emergency. The POLST — which does require a provider's co-signature — is the mechanism for creating a binding, immediately effective DNR order outside the hospital.
• Does an attorney need to be involved in creating a POLST form?+
  No. A POLST form is a medical document, not a legal one. It is created through a conversation between you and your physician, nurse practitioner, or physician assistant — typically in a clinical setting. Attorneys are not involved in drafting, reviewing, or executing a POLST form. An attorney's role in end-of-life planning is to help you complete an Advance Health Care Directive — the legal document that names your health care agent, documents your broader wishes, and gives your agent the authority to speak for you if you lose capacity, including the authority to consent to a POLST on your behalf. Utah's standard statutory form is the right choice for most clients because it is the form medical providers are trained to recognize and locate quickly in urgent situations.