What is a Do Not Resuscitate (DNR) order?
Do not resuscitate (DNR) order for emergency services means a document made pursuant to the Emergency Medical Services Do Not Resuscitate Order Act (hereinafter “the EMS DNR Order Act”), Chapter 78, Title 44 of the SC Code of Laws, to prevent EMS personnel from employing resuscitative measures or any other medical process that would only extend the patient's suffering with no viable medical reason to perform the procedure.
Who can have a DNR order?
A patient who has a terminal condition and terminal condition has been diagnosed by a health care provider and the health care provider’s record establishes the time, date, and medical condition which gives rise to the diagnosis of a terminal condition.
What is a terminal condition?
Terminal condition means an incurable or irreversible condition that within reasonable medical judgment could cause death within a reasonably short period of time if life sustaining procedures are not used.
Who should complete the DNR order form?
A health care provider responsible for the care of the patient may execute the DNR order in accordance with the EMS DNR Order Act. A health care provider is defined by the EMS DNR Order Act to mean a person licensed to practice medicine or osteopathy pursuant to Chapter 47, Title 40 of the SC Code of Laws.
In addition, pursuant to SC Code Section 40-47-935(B)(7), notwithstanding any provisions of state law other than Chapter 47 of Title 40, and to the extent permitted by federal law, a physician assistant (PA) may execute a do not resuscitate order pursuant to the EMS DNR Order Act unless otherwise provided in the scope of practice guidelines.
Also, pursuant to SC Code Section 40-33-34(D)(2)(g), notwithstanding any provisions of state law other than Chapters 33 and 47 of Title 40, and to the extent permitted by federal law, an advanced practice registered nurse (APRN) may execute a do not resuscitate order pursuant to the provisions of the EMS DNR Order Act unless otherwise provided in the practice agreement.
What is a DNR bracelet?
A DNR bracelet obtained in accordance with the SC EMS DNR Order Act (the Act) is a standardized identification bracelet that signifies a patient who has obtained a DNR order that has not been revoked. The DHEC-approved DNR bracelet vendor cannot fulfill a request for a DNR bracelet without receiving a physician’s, physician assistant’s, or advanced practice registered nurse’s order for the bracelet with the request. Pursuant to the Act, the cost of obtaining a bracelet must be borne by the patient and may not be provided by the DHEC or at the expense of the DHEC.
Who can request the DNR order for the patient?
A patient who has a terminal condition, a surrogate for the patient with a terminal condition under the Adult Health Care Consent Act, or an agent of a person with a terminal condition named by the patient in a Health Care Power of Attorney, or a parent or legal guardian with the legal authority to make medical decisions for a child may request the DNR order, in accordance with the EMS DNR Order Act.
What are the duties of EMS personnel when presented with DNR order?
When called to render emergency medical services, EMS personnel must not use any resuscitative treatment if the patient has a "do not resuscitate order for emergency services" and the document is presented to the EMS personnel upon their arrival or if the patient is wearing a DNR bracelet. EMS personnel must provide that degree of palliative care called for under the circumstances which exist at the time treatment is rendered.
What is the liability of health care providers or EMS personnel regarding DNR orders?
No health care provider or EMS personnel is liable for damages, may be the subject of disciplinary proceedings, or may be subject to civil or criminal liability due to:
- issuing a "do not resuscitate order for emergency medical services" or a "do not resuscitate bracelet";
- good faith reliance on a "do not resuscitate order for emergency medical services" or a "do not resuscitate bracelet" resulting in: (a) the withholding of resuscitative treatment; or (b) the withholding of resuscitative treatment already in progress once a duly executed "do not resuscitate order for emergency medical services" is identified;
- initiating resuscitative treatment on a "do not resuscitate patient" if EMS personnel were unaware of the existence of the order or bracelet or if EMS personnel reasonably and in good faith believed the "do not resuscitate order" had been canceled or revoked or, where applicable, if the do not resuscitate bracelet has been tampered with or removed; or
- initiating resuscitative treatment on a "do not resuscitate patient" where in the best medical judgment of EMS personnel, the care was necessary to relieve pain or suffering or to provide comfort care to the patient.
Does a health care provider or EMS personnel have to honor a DNR order or bracelet?
A health care provider and an EMS personnel shall follow the request of the patient and must not provide resuscitative measures when the patient has a "do not resuscitate order for emergency medical services" or is wearing a "do not resuscitate bracelet", except where the:
- order is revoked pursuant to SC Code Section 44-78-60; or
- bracelet, when applicable, appears to have been tampered with or removed.
A health care provider or EMS personnel who cannot honor the order or bracelet immediately must transfer care of the patient to an EMS personnel or health care provider who will honor the order or bracelet.
How can a DNR order be revoked?
A patient or, if the patient is a child, a parent or legal guardian with the legal authority to make medical decisions for the child, may revoke a “do not resuscitate order for emergency services” by:
- mutilating, obliterating, or destroying the "do not resuscitate order for emergency medical services" document in any manner;
- orally expressing to an emergency medical technician, first responder, or to a person who serves as a member of an emergency health care facility's personnel, the desire to be resuscitated, after which the emergency medical technician, first responder, or the member of the emergency health care facility shall disregard the "do not resuscitate order for emergency medical services" document and, if applicable, promptly remove the bracelet;
- defacing, burning, cutting, or otherwise destroying the bracelet, if applicable; or
- removing the bracelet or asking another person to remove the bracelet.
NOTHING IN THESE FAQS SHALL BE CONSTRUED AS LEGAL ADVICE.