In a previous blog post, we discussed how a Health Care Power of Attorney (“HCPOA”) can be used to give someone the power to make medical decisions on your behalf if you are unable to make such decisions for yourself. One of the benefits offered by a HCPOA is that a person can direct his or her medical provider to withhold or withdraw the use of life-sustaining procedures. A Do Not Resuscitate Order (“DNR”), though at times confused with a HCPOA, is a distinct document that goes one step further and effectively prevents Emergency Medical Services (“EMS”) personnel from employing any sort of procedures that would revive the person to whom the DNR applies.
Who can have a DNR?
In order to have a DNR in South Carolina1, a person must be at least eighteen (18) years old and have a “terminal condition” that has been diagnosed by a health care provider. A “terminal condition” is a condition that is considered incurable and irreversible, and that would cause death within a reasonably short period of time if life sustaining procedures are not used. In order to have a DNR, a person’s health care provider must document the time, date and medical condition which gives rise to the diagnosis of the person’s “terminal condition.”
Who requests, prepares, and executes a DNR?
An eligible person, or an eligible person’s surrogate under the Adult Health Care Consent Act or agent under HCPOA, may request a DNR. Once requested, a DNR is prepared and executed by a health care provider. The health care provider must be licensed to practice medicine or osteopathy under South Carolina law. Generally, physician assistants and advanced practice registered nurses cannot execute a DNR.
What is a DNR bracelet?
After a DNR has been executed, the health care provider can request a standardized bracelet from the South Carolina Department of Health and Environmental Control. Once received and when worn, a DNR bracelet serves as notice to all health care providers and EMS personnel that the patient has an effective DNR. If a patient does not have a DNR bracelet, the patient (or someone close to the patient) would have to provide the actual DNR to any health care provider or EMS personnel which would otherwise use resuscitative procedures on the patient.
What are duties do EMS personnel have with respect to a DNR?
EMS personnel are required to refrain from using resuscitative procedures if they have been presented with a DNR for a patient. However, EMS personnel are not subject to disciplinary proceedings, civil, or criminal liability for initiating resuscitative procedures on a patient if the EMS personnel (i) is unaware of the DNR, (ii) reasonably believes the DNR has been canceled or revoked (or if it appears that the DNR bracelet, if any, has been tampered with or removed), or (iii) in his or her best medical judgment, determines that such procedures are necessary in order to relieve pain or suffering, or provide comfort to the patient.
How can a patient revoke a DNR?
A patient can revoke a DNR by (i) damaging or destroying the DNR, (ii) noticeably damaging, cutting or otherwise destroying the DNR bracelet (if any), (iii) removing, or asking someone to remove, the DNR bracelet (if any), or (iv) orally expressing to the health care provider or EMS personnel a desire to be resuscitated (and promptly removing the bracelet, if applicable).
If you have questions about DNRs, HCPOAs, or other aspects of end-of-life planning, we invite you to contact an attorney at Thomas, Fisher & Edwards, P.A. at (864) 232-0041.
1 DNRs are authorized by and subject to the Emergency Medical Services Do Not Resuscitate Order Act, SC Code of Laws Chapter 78, Title 44.
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