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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. |
