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San Antonio Express-News
June 9, 2000

Do Not Resuscitate Orders

© 1989-2004, Paul Premack

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Dear Mr. Premack: If both a Husband and a Wife have signed a Do Not Resuscitate and have given it to their personal Physicians, who then call in Specialists to care for another illness, does their Do Not Resuscitate still stand? My in-laws have been told that a new Do Not Resuscitate has to be filed with each new Physician. At this point, one has had a heart attack, colostomy, and now a stroke. The other has been diagnosed with inoperable cancer. They are both in their late 70's. Thank you for your response. – J.K.M.

To understand the answer to your question, you must first realize that Do Not Resuscitate (DNR) Orders come in two very different varieties. There is an "in-hospital" DNR and an "out-of-hospital" DNR, and each has its own legal requirements.

Both types of DNR have two things in common: 1) They instruct medical personnel to take a hands-off approach when the patient’s heart or respiration stops. Ordinarily, medical personnel are allowed to legally presume that the patient wants life-saving treatment like CPR. A DNR order instructs them to take no life-restoring action; and 2) They are created by the physician, with informed consent from the patient or the patient’s legal representative.

That is where the differences begin. For instance:

· An in-hospital DNR can last anywhere from 24 hours to a week before the doctor has to renew it, depending on the hospital’s policies. An out-of-hospital DNR has no time limit, and is valid until the patient revokes it or dies.

· An in-hospital DNR can be reviewed by a new physician, who may find that the original circumstances have changed. The new physician may remove the DNR order, or recommend that it be suspended while reviewing the patient’s records. An out-of-hospital DNR is valid even if the treating physician is changed.

· An in-hospital DNR can be any wording or form the hospital and doctor find satisfactory. An out-of-hospital DNR must be on a form prescribed by the Texas Department of Health.

· An in-hospital DNR has no special liability-resistant features for the physician, so great care is taken to assure that no wrong move is made. An out-of-hospital DNR does shelter the physician from liability, so it can be implemented without a doctor’s moment-to-moment supervision.

Since I don’t know whether your parents are in the hospital or at home, I don’t know whether their doctor is acting properly.

You should also distinguish DRN orders from Directives to Physicians. The DNR essentially says "If I’ve died, don’t do anything to bring me back." The Directive to Physicians says "I’m fatally ill; don’t do anything to keep me here."

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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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