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Do Not Resuscitate Laws: A Comparison Between Washington and Texas

Doctor advises patient about end of life documents

Dear Mr. Premack: I have an "Out of Hospital Do Not Resuscitate" document signed by me, witnesses, my then Primary Care Physician, and notarized in the state of Texas. I have recently relocated to Washington State. Is my Texas DNR valid in Washington state to avoid resuscitation, which is my wish? – E.A.


Texas uses a state-created Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order to instruct emergency medical personnel and other healthcare professionals to forgo resuscitation attempts allowing the patient to have a natural death with peace and dignity. A Texas OOH-DNR allows a Texas resident to refuse future cardiopulmonary resuscitation (CPR), advanced airway management, defibrillation, artificial ventilations, and transcutaneous cardiac pacing. It does not restrict other emergency care, including comfort care.


A Texas OOH-DNR is not the same as a Texas Directive to Physicians The DNR is used after the patient has already suffered cessation of respiratory and cardiac function. The Directive to Physicians looks to a different time period, when a patient with a terminal condition is approaching death, it allows that patient to avoid artificial life support that would prolong the suffering by artificially though temporarily sustaining the body.


Washington State uses a Portable Order for Life Sustaining Treatment (POLST) to instruct emergency medical personnel and other healthcare professionals to forgo resuscitation attempts. The process may still be referred to as a “do not resuscitate situation” but the POLST paperwork is very different from the Texas OOH-DNR paperwork.


The Washington POLST form was created by the Washington State Department of Health and the Washington State Medical Association. It allows an individual to express their instructions about future end-of-life treatment. It stays with the patient, so it can be used at home, in a nursing facility, or in a hospital setting.

A POLST is also broader in scope than a Texas OOH-DNR. It covers the patient’s wishes regarding resuscitation, medical interventions, antibiotics, and artificial feeding. It is an explicit and immediately enforceable expression of wishes the patient should also express in a legal “Health Care Directive” (to refuse artificial life support) and in a legal “Durable Power of Attorney for Health Care” (to appoint an agent to make future medical decisions if the patient becomes incapacitated).


Since the topic is end-of-life wishes, you should also know that Washington State allows death with dignity while Texas has refused to offer this option to its residents. Since 2009, an adult Washington resident (a) who is diagnosed with and incurable or irreversible disease that will cause death within six months, and (b) who still has the ability to make and communicate an informed decision to health care providers may end their life with a lethal medication.

By law, the Washington patient must make a written request “to end my life in a humane and dignified manner” (using DOH form 422-063). It must be signed by the patient and two witnesses. Then the patient must make the same request verbally to the doctor, two times, at least seven days apart. The doctor may then prescribe the lethal medication, then must file the request with the Washington Department of Health within 30 days.


Death with Dignity is used infrequently. The most current reported numbers are from 2022, when exactly 452 people asked for the prescription. Of them, 80% took the medication and died, while 10% died of their illness without taking the medication, and the final 10% were not reported to the state. These 452 people are from a resident population of around 7.8 million.


In either state, the do not resuscitate laws provide free government forms.

Other Advance Directives, like your Medical Power of Attorney, should be prepared by a knowledgeable attorney as part of a complete estate plan. Your advance medical decisions should be shared with family and confirmed with physicians.


Paul Premack is a Certified Elder Law Attorney for Wills and Trusts, Probate, and Elder Law issues. He is licensed to practice law in Texas and Washington. To contact us, click here.


Column published on April 1, 2024.


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