Ask the Expert

Question:
As a registered nurse and caregiver for my mother, who has been diagnosed with dementia, I am aware of her wishes related to medical interventions she does not want when the time comes for me to make such decisions. (I am her medical power of attorney.)

Is there a law or a legal document in the state of Pennsylvania regarding do-not-resuscitate orders in situations outside medical or caregiving institutions? My mother lives with me, and I want to prevent something contrary to her wishes from happening to her if I were not present when a medical crisis occurs outside of a medical institution or care facility.
 
Diana McCarty, RN
Montoursville, PA

Response:
Traditional do-not-resuscitate orders (DNRs) are given by doctors in hospital settings to direct that resuscitation should not be performed if the patient’s heart or breathing stops. These orders do not follow patients into home or community-based settings.

To address this problem, in 2002, Pennsylvania enacted the Do-Not-Resuscitate Act that provided for out-of-hospital DNRs. This act was repealed and replaced by the Out-of-Hospital Nonresuscitation Act that became effective on January 28, 2007. This act allows individuals who are in an end-stage medical condition or state of permanent unconsciousness to forego CPR by requesting out-of-hospital DNRs from their attending physicians. The physician issues an order along with a bracelet or necklace to alert emergency medical services (EMS) personnel regarding the nonresuscitation order. EMS personnel are required to review and comply with the physician’s order. Physicians can obtain forms for the orders and the necklaces and bracelets from the State Department of Health.

The patient can revoke an out-of-hospital DNR at any time, regardless of his or her mental capacity at the time of revocation. If the patient is mentally incapacitated and unable to request the order himself or herself, a healthcare agent acting on behalf of the patient can request or terminate the order.

— Marielle F. Hazen, CELA, of Hazen Elder Law in Harrisburg, PA, is a certified elder law attorney of the National Elder Law Foundation as authorized by the Pennsylvania Supreme Court.