Legal Definitions - out-of-hospital do-not-resuscitate order

An out-of-hospital do-not-resuscitate (DNR) order is a formal medical instruction, signed by a physician, that directs emergency medical services (EMS) personnel and other healthcare providers *outside* of a hospital setting not to perform cardiopulmonary resuscitation (CPR) or other life-sustaining interventions. These interventions typically include chest compressions, artificial ventilation, intubation, and defibrillation, which are used when a person's heart stops beating or they stop breathing. This specific order ensures that an individual's wishes to decline aggressive resuscitation efforts are honored in non-hospital environments, such as their home, a nursing facility, an assisted living center, or a public place.

Here are some examples illustrating the application of an out-of-hospital DNR order:

• Example 1: An Elderly Individual Living at Home
  Scenario: Mrs. Eleanor Vance, 88, lives independently but has advanced chronic obstructive pulmonary disease (COPD) and congestive heart failure. She has clearly communicated to her family and physician that she wishes to avoid aggressive medical interventions and desires a peaceful passing at home. Her doctor completes and signs an out-of-hospital DNR order, which Mrs. Vance keeps prominently displayed on her refrigerator and provides a copy to her primary caregiver.

  Explanation: If Mrs. Vance were to experience a cardiac arrest or stop breathing at home, and her family called 911, the EMS team arriving at her residence would see the valid out-of-hospital DNR order. This order would direct them not to initiate CPR or other resuscitative measures, respecting her previously stated wishes and ensuring she receives comfort care instead of aggressive life support.

• Example 2: A Hospice Patient in a Residential Facility
  Scenario: Mr. David Chen, 72, is receiving hospice care for terminal pancreatic cancer at a dedicated residential hospice facility. His medical team, in consultation with Mr. Chen and his family, has established an out-of-hospital DNR order as part of his comprehensive end-of-life care plan. The order is kept in his medical file at the facility and a copy is also provided to his family.

  Explanation: Should Mr. Chen's heart stop or he cease breathing while at the hospice facility, the staff and any responding emergency personnel would refer to his out-of-hospital DNR order. This order legally prevents them from attempting resuscitation, aligning with the goals of hospice care which prioritize comfort and dignity over prolonging life through invasive medical procedures.

• Example 3: An Individual with Advanced Dementia in Assisted Living
  Scenario: Ms. Sarah Jenkins, 94, resides in an assisted living facility and has advanced Alzheimer's disease. Several years prior, when she was still able to make decisions, she expressed a desire not to be resuscitated if her health significantly declined. Her daughter, who holds her durable power of attorney for healthcare, worked with Ms. Jenkins' physician to complete an out-of-hospital DNR order, which is kept on file at the assisted living facility.

  Explanation: If Ms. Jenkins were to suffer a medical emergency requiring resuscitation at the assisted living facility, the staff or any paramedics called to the scene would consult her medical records. The out-of-hospital DNR order would instruct them to withhold CPR and other life-sustaining treatments, honoring her earlier expressed wishes and the decisions made on her behalf by her healthcare proxy, even though she is no longer able to communicate those wishes herself.