You or your loved one may have a do-not-resuscitate (“DNR”) order. A DNR order is a document that sets forth your wishes of no resuscitation or other heroic measures in the event your heartbeat or breathing stops. In such a situation, do nothing, let me be and let God’s will be done.
For many years in Michigan, there were two areas of uncertainty regarding DNR orders. The first area was the validity of DNR orders outside of a hospital or other medical facility, such as with a terminally ill patient at home. The second area was regarding a guardian’s legal authority to sign DNR orders on behalf of an incapacitated individual.
Michigan has clarified both of these issues with recent amendments to Michigan’s Do-Not-Resuscitate Procedure Act and the Estates and Protected Individuals Code. These changes became effective this past February and clarify years of uncertainty with these matters.
Prior to these changes, DNR orders were pretty much limited to hospitals, nursing homes and other healthcare facilities. According to the Michigan Department of Community Health, outside of these facilities, licensed healthcare professionals were required to try and revive anyone who had no heartbeat or sign of breathing.
So even when you had a valid DNR order, if EMS was called to your home because you stopped breathing or your heart stopped, they had to administer CPR. This was disconcerting to many families when they thought everything was set for their loved one to die quietly and peacefully at home. Instead, EMS swoops in, straps a mask onto their loved one and starts pounding on their loved one’s chest.
This has been clarified with the new statutes. Now, it is clear that DNR orders are effective outside of medical care facilities. All you have to do is give notice of the DNR order to the healthcare professional. This can be done by you or your loved ones giving a copy of your DNR order to them or you can wear a special DNR bracelet that is specifically provided for in the statute. Once EMS or other healthcare professionals are given notice of your DNR order, they “shall not attempt to resuscitate” you.
The new statute provides the form of the DNR order. You may want to have your existing DNR order reviewed to be assured that it complies with the new statute.
Also prior to the new changes in the law, it was unclear whether a guardian had the authority to execute a DNR order. This was because there was no specific authority in Michigan statutes and there were number of courts which reached differing conclusions.
That has all changed with the new law. Now by Michigan statute, guardians have specific authority to execute, reaffirm and revoke DNR orders on behalf of incapacitated individuals.
However, before the guardian signs a DNR order on behalf of an incapacitated individual, the guardian must do the following:
Not more than 14 days before signing the DNR order, the guardian visits the incapacitated individual and, if meaningful communication is possible, consults with the individual about executing the DNR order.
The guardian consults directly with the incapacitated individual’s attending physician as to the specific medical indications that warrant the DNR order.
In addition, when a DNR order has been signed by a guardian on behalf of an incapacitated individual, every year the guardian has to do the following:
Visit the incapacitated individual and, if meaningful communication is possible, consult with the individual about reaffirming the DNR order.
Consult directly with the incapacitated individual’s attending physician as to specific medical indications that may warrant reaffirming the DNR order.
These new guardian powers regarding DNR orders do not affect or limit the power of a guardian to consent to a physician’s DNR order in a hospital. This is because there are different rules regarding in-hospital DNR orders and DNR orders outside the hospital.
There are basically two types of DNR procedures in Michigan. One type of procedure is used in hospitals and other healthcare facilities. The other type is used outside of hospitals and other healthcare facilities.
The DNR orders that are used in Michigan hospitals and other healthcare facilities are not specifically authorized by Michigan statute, but are still legal. They are governed by general medical practices. This type of DNR order is a physician’s order that is entered in a healthcare facility’s patient’s records with the consent of the patient or the patient’s authorized representative.
The DNR order used outside of a hospital or other healthcare facility is specifically authorized by Michigan law. The DNR order has to be in a specific form that is provided by statute and can be signed by the individual, or as set forth above, his or her guardian. The DNR order used outside of a hospital or other healthcare facility can also be signed by an individual’s patient advocate, so long as it complies with the patient advocate statute.
So now under Michigan statute, it is clear who has authority to execute DNR orders for you, so that you can be assured that your wishes are followed.
By: Matthew Wallace CPA, JD
Published edited May 11, 2014 in The Times Herald newspaper, Port Huron, Michigan as: State clarifies do-not-resuscitate act