I have written in the past about the prehospital medical care directive, also known as a “do-not-resuscitate” instruction or “DNR.” I am asked about it frequently, but not many people actually sign one after I explain it to them. The law on the DNR is actually relatively straightforward, although it seems that few people have a clear understanding of what a DNR is and how it works.
The term “prehospital medical care directive” isn’t really an accurate description of the DNR, since the DNR deals only with cardiac or respiratory arrest, and specifically with cardiopulmonary resuscitation and related emergency procedures in the event of cardiac or respiratory arrest. The term “do not resuscitate” is actually a much more accurate description of what the DNR is about.
Section 36-3251 of the Arizona Revised Statutes lays out the basic terms for a prehospital medical care directive in pretty uncomplicated language. Here’s what it says:
Notwithstanding any law or a health care directive to the contrary, a person may execute a prehospital medical care directive that, in the event of cardiac or respiratory arrest, directs the withholding of cardiopulmonary resuscitation by emergency medical system and hospital emergency department personnel.
Next, the statute spells out what the DNR is not about:
Authorization for the withholding of cardiopulmonary resuscitation does not include the withholding of other medical interventions, such as intravenous fluids, oxygen or other therapies deemed necessary to provide comfort care or to alleviate pain.
In other words, the DNR is not the same as a living will. If you want to give instructions about withholding other types of medical treatment, you want a living will, not a DNR (although a living will can say that you don’t want medical providers to administer cardiopulmonary resuscitation).
The next part of the statute provides what the DNR must say, and specifies that it must be on orange paper, either letter or wallet size. The operative provisions of the DNR say this:
In the event of cardiac or respiratory arrest, I refuse any resuscitation measures including cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of advanced cardiac life support drugs and related emergency medical procedures.
The form then has spaces for the signature and personal identifying information of the person adopting the directive. The form also requires a signature by a licensed health care provider after the following statement:
I have explained this form and its consequences to the signer and obtained assurance that the signer understands that death may result from any refused care listed above.
Finally, the form requires the signature of a witness who must attest that he or she was present when the document was signed and that “the patient then appeared to be of sound mind and free from duress.”
The statute also says that a person who has a valid prehospital medical care directive “may wear an identifying bracelet on either the wrist or the ankle,” which “shall be substantially similar to identification bracelets worn in hospitals [and] shall be on an orange background and state . . . in bold type . . . Do Not Resuscitate” with the person’s name and the name of their physician. So if you have a signed DNR directive that meets the requirements of the statute, you can also wear a bracelet to let medical care providers know that you don’t want to be resuscitated.
According to the legislative history, the statute that provides for the prehospital medical care directive was first adopted in 1992. I can’t say how many of them I have prepared in my almost thirty years as a practicing attorney, but I do know that we don’t use up that orange paper very quickly. Usually the people who ask about it decide they don’t want it once I explain what it means.
What’s the practical effect of a DNR, if you do sign one? Here’s how I describe what the DNR means in layman’s terms: it means that when the paramedics come to your house and find you unconscious and not breathing, as soon as they see the orange sheet of paper on your refrigerator, they do nothing but turn around and leave.
Should you have a DNR? It’s a personal choice, of course. There are perfectly legitimate reasons why some people think the DNR is a good idea. Usually, however, the people I talk to are more comfortable with a living will. The living will is another document provided for in Arizona law that’s a broader set of instructions, intended to control a range of health care treatment decisions that can be made on behalf of a person who signs one.
Nathan B. Hannah is a Shareholder in the Tucson office, and practices in the areas of estate planning and administration, real estate, and commercial transactions. He is also a noted blogger, and you can find more of his articles on his private blog,
Contact Attorney Hannah: firstname.lastname@example.org or 520/ 322-5000
This communication is designed to bring legal developments of interest to the attention of our clients and others. It should not be relied upon as a substitute for specific legal advice in a particular matter. For further information on any of the subjects discussed, or for legal advice in connection with any particular matter, please contact us.