DNR vs POLST in Montana: Which Form Do You Need?

DNR vs POLST in Montana: Which Form Do You Need?

If you or a family member has a serious illness in Montana, you have probably heard "DNR" and "POLST" used interchangeably. They are not the same thing, and confusing them can lead to medical interventions you never wanted — or the withholding of care you actually need.

What a DNR Order Does

A Do Not Resuscitate (DNR) order addresses one specific scenario: what happens if your heart stops or you stop breathing. If a signed DNR is present and accessible, emergency medical personnel will not attempt cardiopulmonary resuscitation (CPR).

That is the full scope of a DNR. It says nothing about ventilators, feeding tubes, IV antibiotics, pain management, or hospital admission. If you arrive at a Montana emergency room in respiratory distress but your heart is still beating, a DNR has no bearing on your treatment.

A DNR must be signed by both a physician and the patient (or their legal proxy). In Montana, the original is typically kept in the home — often on the refrigerator or inside the front door — or worn as a state-approved medical bracelet.

What a POLST Does

Montana's Provider Orders for Life-Sustaining Treatment (POLST) is far more comprehensive. It is a portable medical order — printed on distinctive "terra green" paper — that translates your current treatment preferences into active, enforceable instructions across multiple medical scenarios:

• CPR: Full resuscitation, or do not attempt
• Medical interventions: Full treatment, selective treatment, or comfort-focused treatment only
• Mechanical ventilation: Whether you want intubation
• Artificial nutrition: IV fluids, feeding tubes, or neither
• Antibiotics: Full course, limited use, or none

A POLST must be signed by both a licensed medical provider (physician, APRN, or physician assistant) and the patient or their legal surrogate. It is generated through a direct clinical conversation about your current medical status and prognosis — not a general planning exercise.

Side-by-Side Comparison

The Critical Gap: What Happens Without a POLST

Here is the scenario that catches families off guard: A terminally ill Montana resident has a Living Will and a DNR, but no POLST. They collapse at home and someone calls 911. When paramedics arrive, the patient still has a heartbeat but is in severe respiratory distress.

The DNR does not apply — the heart has not stopped. The Living Will is a planning document, not a medical order — EMTs are not authorized to interpret it on scene. Without a POLST specifying "comfort measures only," the paramedics are legally obligated to provide full emergency treatment, including intubation and transport to the nearest hospital.

This is exactly the kind of aggressive intervention many terminally ill patients specifically want to avoid.

When You Need Which

DNR alone works if your only concern is preventing CPR after cardiac arrest, and you are otherwise comfortable receiving full medical treatment.

POLST is appropriate if you have a serious, life-limiting illness and want to specify the full range of interventions you will and will not accept. A POLST effectively includes the DNR question (Section A asks about CPR), so you typically do not need a separate DNR if you have a POLST.

Both documents assume you already have an Advance Directive. Neither a DNR nor a POLST replaces your Living Will or Durable Power of Attorney for Health Care. Your advance directive is the long-term planning document that expresses your values and names your healthcare agent. The POLST and DNR translate those values into immediate medical orders.

How to Get a POLST in Montana

You cannot download a POLST and fill it out yourself. It must be completed through a clinical consultation with your physician, APRN, or PA. The conversation covers your diagnosis, prognosis, and specific treatment preferences. The provider then generates the form on the official terra green paper, and both parties sign.

The original travels with you — in a green envelope on the refrigerator at home, in your medical chart at a facility, or handed directly to paramedics during transport. Copies should go to your healthcare agent and your primary care physician's office.

Putting It All Together

The complete protection package for a seriously ill Montana resident includes:

1. Advance Directive (Living Will + Healthcare POA) — your foundational values document
2. POLST — your active medical orders for current treatment
3. Montana End-of-Life Registry registration — ensures any provider in the state can access your directive in an emergency

The Montana Advance Directive & Living Will Kit covers step one — the foundational document you need before discussing POLST options with your physician. It includes the statutory forms, witness requirements, and registry submission instructions.

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