Advance Health Care Directive, POLST, and DNR: What Each Document Does and What Changes in 2027

Few moments are harder for a family than a hospital conversation about life-sustaining treatment. A doctor asks whether Mom has “a POLST” or “a DNR,” and the family realizes they are not sure what she signed, or whether the document they have in a folder at home is the one that matters.

California uses several different documents to record health care wishes, and they are easy to confuse. A new law, Senate Bill 1088, also updates how two of them work. This guide explains the difference in plain language and what the changes may mean for your family.

The Advance Health Care Directive: Your Long-Term Plan

An advance health care directive is a legal document you sign while you have capacity. In California, it generally does two things:

• Names a health care agent. This is the person you trust to make medical decisions for you if you cannot make them yourself. You can also name alternates.
• Records your health care instructions. You can state your wishes about life-sustaining treatment, pain relief, organ donation, and other matters, so your agent and doctors understand your values.

California law provides the statutory requirements for this document, and an estate planning attorney can prepare a directive tailored to your circumstances. At Goodman Estate Law, the health care directive also includes a HIPAA authorization, so your agent can obtain medical information without a separate document.

An advance health care directive is meant for every adult, not just older adults or people who are ill. Our article on the two documents every new adult needs at 18 explains why even young adults benefit from one.

In most cases, an advance health care directive must be signed before two qualified witnesses or acknowledged before a notary public. Additional witnessing rules may apply to residents of skilled nursing facilities.

POLST: A Medical Order for Serious Illness

A POLST is a different kind of document. Rather than a legal planning document, it is a medical order that a patient, or their legally recognized decision-maker, completes together with a physician, nurse practitioner, or physician assistant. It is printed on a recognizable form and travels with the patient, often posted on the refrigerator at home or kept in the patient’s chart at a care facility.

A POLST is generally intended for people with serious illness or advanced frailty. It translates their wishes into specific instructions that emergency responders and hospital staff can follow immediately, such as whether to attempt CPR and what level of medical intervention to provide.

The key distinction is timing and audience. Your advance health care directive tells your agent and doctors how to make decisions over time. A POLST tells the paramedics who arrive at your door what to do in the next ten minutes.

DNR: A Narrow Instruction About Resuscitation

A prehospital “do not resuscitate” form, commonly called a DNR, is narrower still. It instructs emergency medical personnel not to attempt resuscitation, such as CPR, if a person’s heart or breathing stops. California law treats both DNR forms and POLSTs as “requests regarding resuscitative measures,” and both are medical orders rather than estate planning documents.

Comparing the Three Documents

What SB 1088 Changes

Governor Newsom signed SB 1088 on September 27, 2026, as Chapter 677 of the Statutes of 2026. Sponsored by the Coalition for Compassionate Care of California, the bill updates the Probate Code sections that govern POLST and DNR forms. Key changes include:

• Electronic signatures. An electronic signature is sufficient for required signatures on these forms, which may make it easier to complete them during telehealth visits or in facilities that use electronic records.
• Out-of-state forms are recognized. A form executed in another state is valid and enforceable in California if it complies with the law of that state or of California. Health care providers may presume such a form is valid and has not been revoked unless they know otherwise. This matters for retirees who split time between Orange County and another state.
• More clinicians can sign a DNR. Nurse practitioners and physician assistants, in addition to physicians, can sign DNR forms, consistent with the rules already in place for POLST.
• Completing a form is voluntary. The law states that completing one of these forms is entirely voluntary, and health care or admission to a facility cannot be conditioned on whether a person completes or refuses one.
• Clarifying the difference. The law confirms that a POLST is not an advance health care directive, and it directs providers to explain the difference to patients.
• Updated name and acknowledgment. The form’s full name is updated to “Portable Orders Listing Scope of Treatment,” and printed forms dated after January 1, 2027, must include an acknowledgment that an agent, conservator, or surrogate who signs is acting consistent with the person’s known wishes and best interest.

How These Documents Work Together

These documents are not alternatives to one another. For most families, the advance health care directive is the foundation. It names the person who will speak for you, and that person may later help complete a POLST with your doctor if your health declines and you can no longer do so yourself. Under the updated law, an agent, conservator, or surrogate may sign a POLST on a person’s behalf only if the person lacks capacity or has designated that authority.

If a POLST and your health care instructions directly conflict, California law generally gives effect to the most recent order or instruction, to the extent of the conflict. That is one reason it helps to review both documents together whenever your health changes.

An Orange County Example

Consider a Laguna Niguel woman in her late seventies who signed an advance health care directive with her estate plan years ago, naming her daughter as agent. After a heart failure diagnosis, she and her cardiologist complete a POLST that reflects her wish to avoid aggressive treatment. She spends winters with her son in Arizona. Under SB 1088, a comparable form she signs there may be recognized when she returns to California, and her daughter, as agent, remains the person who speaks for her on decisions the POLST does not address.

When to Review Your Health Care Documents

It may be time to review your advance health care directive, and to talk with your doctor about whether a POLST is appropriate, if:

• You receive a serious diagnosis or your health changes significantly.
• The agent you named has passed away, is no longer the right choice, or lives far away.
• You are moving into assisted living or a care facility.
• You spend part of the year in another state.
• Your directive was signed many years ago and no longer reflects your wishes.

Health care documents work best alongside a financial power of attorney. Our article on powers of attorney during a sudden illness explains how the two fit together, and our guide to powers of attorney versus conservatorship explains what can happen when these documents are missing.

About the Author

Brett J. Goodman is a California-licensed estate planning attorney serving families throughout Orange County from his office in Anaheim. He earned his Juris Doctor from Chapman University’s Dale E. Fowler School of Law and his undergraduate degree in Middle Eastern Studies and Arabic from Brigham Young University. Brett began his professional career at PricewaterhouseCoopers before moving into estate law. He serves as a board member of the J. Reuben Clark Law Society, Orange County Chapter, and is fluent in Spanish. Brett grew up in Tustin and lives in Villa Park with his wife and three children.

Sources

• SB 1088 (Blakespear), Chapter 677, Statutes of 2026, chaptered text (LegiScan): https://legiscan.com/CA/text/SB1088/id/3460399
• California Hospital Association, SB 1088 summary: https://calhospital.org/legislation/sb-1088-blakespear-d-carlsbad/
• Senator Catherine Blakespear, press release on SB 1088: https://sd38.senate.ca.gov/news/senate-passes-sen-blakespears-legislation-strengthen-end-life-care-protections
• California Attorney General, Advance Health Care Directive Form (Probate Code section 4701): https://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf
• Coalition for Compassionate Care of California, CA POLST: https://capolst.org/

Goodman Estate Law

Brett J. Goodman is the founder and lead attorney at Goodman Estate Law, based in Laguna Hills, CA. The firm specializes in Estate Planning, Trust Administration, and Probate, helping individuals and families create or update wills and trusts. With a focus on personalized, compassionate, and professional guidance, Goodman Estate Law ensures clients’ assets and futures are protected during every stage of estate planning.