The California legislature has given state residents several ways to advise health care providers about their health care decisions. California residents can prepare a statutory form Advance Health Care Directive, which allow someone other than an adult patient being treated to make health care decisions for that patient even when the patient is disabled or incapacitated. Today I will discuss California’s “Do Not Resuscitate” (“DNR”) order form.
Unless provided with contrary written instructions, paramedics, emergency medical treatment and other medical providers usually will try to resuscitate a person whose heart or breathing has stopped. A person who does not want to be resuscitated in such circumstances can give written instructions to that effect on a DNR order form which complies with the requirements of the California Probate Code.
Usually persons who want DNR order forms are patients not likely to benefit from resuscitation efforts. These include persons who have severe kidney problems, who have cancer that has spread, who have serious infections like pneumonia that require hospi-talization, or who need substantial assistance with their daily care.
A person coming within these categories should discuss the possible benefits and detriments of resuscitation efforts and the appropriateness of a DNR order with his or her physician before becoming seriously ill to the point of being incapable of making an informed decision. Consultation with a physician is a requirement for a DNR order, since a DNR order must also be executed by the requesting person’s physician and placed in his or her permanent medical record.
A patient executing a DNR order form normally would not receive the following types of treatments: cardiopulmonary resuscitation (“CPR”), which consists of mouth-to-mouth breathing and chest compression, assisted breathing with mechanical devices, electric shocks to the heart, placement on life support machines such as a breathing machine or ventilator, or treatment with medications that would artificially restart a stopped heart. A patient with a serious illness or terminal condition may not want any form of resuscitation that might merely delay his or her death or increase his or her pain. A DNR order only applies when the heart or breathing has stopped, so a patient with a DNR order will continue to receive full treatment for conditions like bleeding, pain, shortness of breath or a blocked or obstructed airway. A DNR order form can also be executed on behalf of an incapacitated patient by a patient’s legal representative, such as a Health Care agent, a court-appointed conservator, a spouse, or another family member. Such a form must also be executed by the patient’s physician, confirming that there was informed consent to the DNR decision.
Health care providers and hospitals routinely have blank paperwork for DNR order forms which can be obtained by a patient upon request. Such forms and explanatory materials can also presently be obtained on the Internet at the Orange County Medical Services Agency website: www.ochealthinfo.com/docs/forms/ems_dnr_form.pdf. A person who wants a DNR order also can contact the MedicAlert(R) Foundation to obtain information about Do Not Resuscitate-EMS bracelets and medallions. A DNR order will be disregarded whenever a patient decides that he or she wants to receive full treatment and a DNR order may be revoked at any time. This can be done by physically destroying the DNR order form, by indicating that it is revoked, verbally or in writing, or by removing any bracelet or medallion indicating a DNR request. Copies of your DNR order form should be given to your doctor and other health care providers. A DNR order form should be kept in your wallet or purse or can be disclosed to health care providers by wearing a DNR medallion or bracelet. By doing this, you can assure that your health care instructions will be followed if you become incapacitated or disabled.
The foregoing discussion is intended solely as a general overview of the law, is not to be considered as legal advice, and may not apply to the reader’s particular case. Readers are cautioned to consult with legal counsel of their own selection with respect to any specific situation.
© 2010 by Michael Fate