The Out-Of-Hospital Do Not Resuscitate Order – A Document That You May Not Want To Sign Now
Previously we looked at two “must-have” Texas documents: the Medical Power of Attorney and the Directive to Physicians. Rounding out the Medical Advance Directives triumvirate is the “Out-of-Hospital Do Not Resuscitate Order.”
While the other two documents are serious, this document wins the prize for being the most intense. It is your instruction that you should not be resuscitated by CPR, advance airway management, artificial ventilation, defibrillation, transcutaneous cardiac pacing or any other life-sustaining treatment specified in the Texas statute.
If you are competent, then you can sign your own OOH DNR. You must sign in front of two witnesses or in front of a notary. Unlike the other two documents, however, the OOH DNR is not valid unless it has also been signed by your physician.
While you can sign the document at any time, you should carefully consider if you really want this one to be effective now. For most people, this is a document that should be signed only at the end stages of a terminal or irreversible condition.
The “out-of-hospital” coverage for the document is surprisingly broad. It is effective in locations where health care professionals are called for assistance. That includes long-term care facilities, in-patient hospice facilities, private homes, hospital or stand-alone outpatient or emergency departments, physician’s offices, or vehicles during transport.
The coverage does not include, obviously, in-patient hospital areas. There is a different document for that, creatively named “In-Hospital Do Not Resuscitate Order.” Since your out-of-hospital DNR is not effective in a hospital setting, you can request that an in-hospital DNR be placed in your medical records so the hospital staff does not perform CPR on you. Like your OOH DNR, the in-hospital DNR has to be counter-signed by your doctor.
Once you have an OOH DNR, then your next step is to make sure everyone knows about it. You should purchase a DNR Identification device which can be worn around your neck or as a bracelet. You should tell your caregivers and keep a copy of your OOH DNR near you, prominently displayed. Hospice companies will routinely request a copy for their records.
Be forewarned: having the OOH DNR is not a guarantee that it will actually be followed. While a health care professional is required to comply with a valid OOH DNR if the professional actually knows about it, the professional is also required to determine that the OOH DNR has been properly executed and verify your identity. In the real world, that means that, when in doubt, emergency personnel and other health care professionals will resuscitate you.
An OOH DNR is effective until it is revoked. How do you revoke it? You can destroy the form and remove your identification device, you can revoke it in writing, or you can verbally communicate to a health care professional that you want it revoked.
Now for the fine print. An OOH DNR will not be honored if you are pregnant. An OOH DNR can only be used in conjunction with the “natural process of dying.” If you have revoked an OOH DNR, you can re-execute it at any time. If you don’t have capacity, if you do not have a guardian, and an OOH DNR is appropriate, then it can be executed by (in this order) your spouse, your reasonably available adult children, your parents, or your nearest living relative.