An individual is not required to consent to a DNR order as a condition of treatment or care.
I. General Considerations
Are health-care providers required to honor a DNR order completed on the IDPH Uniform DNR Advance Directive?
Licensed hospitals, certain licensed long-term care facilities such as nursing homes, and licensed emergency medical services personnel must honor a DNR order, or a copy of an order, completed on the IDPH Uniform DNR Advance Directive.
How may the new IDPH Uniform DNR Advance Directives be obtained?
The Illinois Department of Public Health will print the IDPH Uniform DNR Advance Directives on brightly-colored paper. These forms may be ordered at no charge from the Illinois Department of Public Health by calling 217-785-2080. Forms also may be downloaded from the Department’s Web site at www.idph.state.il.us/public/books/advin.htm.
Are photocopies of the IDPH Uniform DNR Advance Directive valid?
Generally, yes. Photocopies of a completed IDPH Uniform DNR Advance Directive are valid. Each health-care facility, however, may have different policies on whether copies of DNR orders completed on a form other than an IDPH Uniform DNR Advance Directive are accepted as valid. It is advisable to check with a health-care facility regarding its DNR policy.
Why does the new IDPH Uniform DNR Advance Directive make a distinction between full cardiopulmonary arrest and pre-arrest emergency?
The section for “pre-arrest emergency” provides additional guidance to health-care providers when a patient has a DNR Order, and breathing is labored or stopped, but the heart is still beating. For example, an individual can specify that if he or she is in a pre-arrest emergency, CPR should be attempted. When an individual does not want any intervention, even at the pre-arrest emergency stage, he or she can state his or her wish not to have CPR attempted.
II. Completing and Reviewing the IDPH Uniform DNR Advance Directive
When is the best time to discuss the form with an individual?
Although it is not always possible, the ideal time for discussion is when the individual is alert and able to articulate his or her wishes about end-of-life care.
Who may consent to a DNR order?
Consent may be obtained from the individual, or from another person legally authorized to act on that person’s behalf such the individual’s legal guardian, agent under a power of attorney for health-care or a surrogate decision maker. A parent or legal guardian typically may consent to a DNR order for a minor. Emancipated minors also may consent to a DNR Order.
Does the IDPH Uniform DNR Advance Directive require the signature of the person who is consenting to the DNR order?
Yes. The patient or his or her authorized legal representative must sign the section of the form concerning consent to the DNR order.
Why does the individual (or his or her legal representative) and a physician sign the IDPH Uniform DNR Advance Directive?
The law authorizing the development of the form specifies that an individual (or his or her authorized legal representative) may execute the IDPH Uniform DNR Advance Directive directing that resuscitation efforts shall not be attempted. Therefore, a DNR order completed on the IDPH Uniform DNR Advance Directive contains an advance directive made by an individual (or legal representative), and also contains a physician’s order that requires a physician’s signature.
Is a witnesses required for the IDPH Uniform DNR Advance Directive?
Yes. One individual, 18 years of age or older, must witness your signature or your legal representative’s signature granting consent on the IDPH Uniform DNR Advance Directive. A witness may include a family member, friend or health-care worker.
Is the order valid if the back of the form has not been completed?
The order can be valid even if the back of the form has not been completed. However, it is advisable to periodically complete and document the review.
What if an individual decides to revoke a DNR Order?
An individual or his or her legal representative can revoke a DNR order. The DNR order can be revoked in a variety of ways, such as by writing “VOID” in large letters across the front of the form. The revocation decision also should be communicated to the individual’s health-care professionals and providers, and to family members.
III. Implementing a DNR order on an IDPH Uniform DNR Advance Directive
Does the law address the potential liability of a health-care provider or professional in connection with implementing a DNR order on an IDPH Uniform DNR Advance Directive?
Subsection (d) of Section 65 of the Health Care Surrogate Act, 755 ILCS 40/65, provides:
“A health care professional or health care provider may presume, in the absence of knowledge to the contrary, that a completed Department of Public Health Uniform DNR Order or a copy of that form is a valid DNR Order. A health care professional or health care provider, or an employee of a health care professional or health care provider, who in good faith complies with a do-not-resuscitate order made in accordance with this Act is not, as a result of that compliance, subject to any criminal or civil liability, except for willful and wanton misconduct, and may not be found to have committed an act of unprofessional conduct.”
Are DNR orders ever suspended during a surgery or other medical procedures?
Certain health-care providers in Illinois have written policies indicating that a DNR order may be suspended during a surgical procedure after discussion with the individual or the individual’s legal representative. Further, a patient’s wishes regarding applicability of a DNR order during surgery or in the event of an unforeseen accident (such as a car crash or choking on food) may be placed on the IDPH Uniform DNR Advance Directive in the space designated for “other instructions”.
IV. Other Resource Links directly to the governing provisions of law in the:
Nursing Home Care Act
Emergency Medical Services ( EMS) Systems Act
Hospital Licensing Act
Illinois Living Will Act
Health Care Surrogate Act
Mental Health Treatment Preference Declaration Act
Illinois Power of Attorney Act
The Illinois Department of Public Health has provided this guidance document for general informational purposes. Because each individual situation is different and key facts can so often change the outcome, additional questions should be directed to a licensed attorney, as IDPH cannot provide legal advice.