| Download the new Do Not Resuscitate Order Form (the form requires Adobe Acrobat Reader.) REMINDER: The form needs to be copied on colored paper similar to CANARY YELLOW. |
| Your responsibility as a health care provider is to be certain that the person is making a willful choice and is not unduly influenced by family or reacting to depression or some other medical condition. |
In 1999, the Florida Legislature created the authority for a universal do-not-resuscitate form that can be used by all health care providers. This will make it much easier for nursing homes to honor the resident's wishes.
There are, however, several points that you must keep in mind.
The form is significantly simplified from the previous form. It does not include a designation for terminal diagnosis. However, while the form may not require the diagnosis, it is our opinion that under certain circumstances, a diagnosis of terminal illness, persistent vegetative state or end stage condition must be made. Rather than clutter this article with a lot of verbiage, I will use the phrase "terminal illness" to include all three of these.
A person who is competent to make medical decisions, can make all of her decisions regardless of condition. Therefore, a competent person may make a decision to refuse resuscitation and those wishes should be carried out.
Your responsibility as a health care provider is to be certain that the person is making a willful choice and is not unduly influenced by family or reacting to depression or some other medical condition.
The right to refuse treatment is not diminished if a person becomes incompetent to make medical decisions. However, the knowledge of a person's wishes may be harder to acquire. If the person has a living will, that is compelling evidence of his wishes. However, you must remember that a living will is only effective if the person is terminal, end stage, etc. Since a living will covers life prolonging procedures and resuscitation is such a procedure, it follows that a person may have resuscitation withheld if that person has a living will and is terminal.
Living will vital
The more difficult situation occurs when a person does not have a living will. Florida law recognizes that a surrogate, designated by the resident, or a proxy, designated by the health care provider in conformance with the law, may make life-prolonging decisions. However, these two can only do so if the resident is terminal, end stage, etc. Thus if the do-not-resuscitate form is signed by one of these, the resident must be terminal and so noted in your medical records.
The difference between the surrogate and proxy making these decisions is one of evidence. If the surrogate, as designated by the resident, is making the decision, you can presume that the surrogate is carrying out the wishes of the resident, absent some knowledge that he is not. If the proxy is making the decision, you should still get clear and convincing evidence from him regarding the resident's wishes.
The form includes a place for the agent under a durable power of attorney to sign. The requirements for designating a surrogate and agent under a DPOA are identical, so, in essence, by creating a DPOA for medical decisions, the resident is creating a health care surrogate designation form. The same rules apply.
Legal protection
You should use the form. By statute, it protects you from civil and criminal liability. It also protects the professionals in your facility from action against their licenses. These protections are only afforded if you are acting in good faith and use the form.
You cannot require a form to be completed as a condition of admission or continued stay. You can, however, explain the benefits of the form to your residents and assist them in completing them if they wish.
You cannot refuse to allow a resident to use the form. This would violate the resident's right to make health care decisions. The universal form may be the only one accepted by other health care providers, including the hospital and emergency medical technicians.
You can also have your own form in addition to the universal form, but you cannot refuse to honor the universal form if the resident will not sign your form. We recommend use of the new form, as it simplifies matters and helps eliminate potential error. We do recommend that you get a separate doctor's order and maintain it in your standard physician's orders. This protects the resident from being inadvertantly resuscitated.
The form must be on yellow paper. The form itself states that either the original or a copy will be honored. You can duplicate your own forms.
Florida Health Care Association will have blank forms available for you.
There is also a provision in the law for use of smaller orders, which can be laminated and kept with the resident. These are also a handy means of carrying out the resident's wishes.
Finally, you need to adopt policies and procedures in compliance with this new law. I expect that once this system is implemented, all of our jobs will be easier.
Universal Do-Not-Resuscitate Update offered by Goldsmith & Grout, P.A.
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