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San Antonio Express-News, October 10, 1996

Refusing "Resuscitation" is Legal


© 1989-2004, Paul Premack

Dear Mr. Premack: My father was recently released from the hospital. He’s had a stroke and has heart trouble. The stroke was bad, and he can’t move or communicate well. I am also a nurse, and I know that in the hospital patients like my father are often put under "DNR" orders. He’s always said he wouldn’t want extreme measures to save his life. Since he’s at home under 24 hour care, is there any legal way to use a DNR order for him? -- L.B. 

A "DNR" order means "do not resuscitate." If a patient’s heart stops, or their respiration ceases, the DNR allows the medical staff to take no action.

DNRs have been in use in hospitals for many years. The patient himself, or the patient’s legally authorized representative, must request that a DNR order be placed on his chart. The doctor, after obtaining informed consent from the patient, signs the order. If the patient later "codes" (goes into cardiac or respiratory arrest) the staff does not take any action to restore those functions.

Your father is at home, under 24 hour nursing care. Until recently, he could not authorize a DNR in the home setting. However, last year a new law went into effect that allows out of hospital DNR orders.

Legally, an out of hospital DNR can be created in several ways. A competent patient has two choices: First, the patient can request that the caregiver provide a form to be signed. The form is written by the Texas Board of Health, and it must be witnessed by two disinterested persons and the doctor. Not surprisingly, the witness requirements are identical to those needed to create a Natural Death Directive.

Second, a competent patient can authorize the DNR by "non-written communication" – meaning by the spoken word or by positive physical response to questions asked. The "communication" must be made in the presence of the witnesses and the doctors. The form must still be filled out and witnessed as before. The doctor must sign it as well.

What if the patient is so ill that he’s considered incompetent? Here, four choices exist. First, if the patient had signed a Natural Death Directive then the doctor can authorize a DNR as an extension of the Directive. Second, if the patient had appointed an Agent under a Durable Power of Attorney for Health Care, the Agent can issue the DNR on behalf of the patient. Third, if the court has appointed a Guardian, the Guardian can issue the DNR for the patient.

When no advance directives have been signed, the forth choice is available: two qualified relatives can issue the DNR for the patient. The law does not define exactly who is "qualified," but other statutes point to the spouse and children having highest priority.

Your father has already expressed his desire to stay away from extreme life saving measures. If he has a Natural Death Directive, ask the doctor to issue a DNR. If not, work with another relative to have a DNR issued. The more pre-planning that can be done, the more smoothly your father’s wishes will be honored.

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Disclaimer: This column answers a specific legal question offered by an individual in the South Texas area. The answer may or may not match your individual situation. Be careful not to treat this column as specific legal advice that meets your individual needs. It may give you a solid basis for discussion with your own attorney. Also, please be aware that laws change. You should consult with your personal attorney before you take any action on this or any legal issue.


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