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Statutes > Indiana > Title16 > Ar36 > Ch5

IC 16-36-5

    

Chapter 5. Out of Hospital Do Not Resuscitate Declarations

IC 16-36-5-1

"Cardiopulmonary resuscitation" or "CPR" defined
    

Sec. 1. As used in this chapter, "cardiopulmonary resuscitation"
or "CPR" means cardiopulmonary resuscitation or a component of
cardiopulmonary resuscitation, including:
        (1) cardiac compression;
        (2) endotracheal intubation and other advanced airway
management;
        (3) artificial ventilation;
        (4) defibrillation;
        (5) administration of cardiac resuscitation medications; and
        (6) related procedures.
The term does not include the Heimlich maneuver or a similar
procedure used to expel an obstruction from the throat.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-2

"Competent witness" defined
    

Sec. 2. As used in this chapter, "competent witness" means a
person at least eighteen (18) years of age who is not:
        (1) the person who signed an out of hospital DNR declaration
on behalf of and at the direction of the declarant;
        (2) a parent, spouse, or child of the declarant;
        (3) entitled to any part of the declarant's estate; or
        (4) directly financially responsible for the declarant's medical
care.
For purposes of subdivision (3), a person is not considered to be
entitled to any part of the declarant's estate solely by virtue of being
nominated as a personal representative or as the attorney for the
estate in the declarant's will.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-3

"Declarant" defined
    

Sec. 3. As used in this chapter, "declarant" means a person:
        (1) who has executed an out of hospital DNR declaration under
section 11(a) of this chapter; or
        (2) for whom a representative has executed an out of hospital
DNR declaration under section 11(b) of this chapter;
and for whom an out of hospital DNR order has been written under
section 12 of this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-4

"DNR" defined
    

Sec. 4. As used in this chapter, "DNR" means do not resuscitate.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-5

"Out of hospital" defined
    

Sec. 5. As used in this chapter, "out of hospital" refers to a
location other than:
        (1) an acute care hospital licensed under IC 16-21-2; or
        (2) a health facility licensed under IC 16-28.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-6

"Out of hospital DNR declaration and order" defined
    

Sec. 6. As used in this chapter, "out of hospital DNR declaration
and order" means a document executed under sections 11 and 12 of
this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-7

"Out of hospital DNR identification device" defined
    

Sec. 7. As used in this chapter, "out of hospital DNR
identification device" means a device developed by the emergency
medical services commission under section 17 of this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-8

"Qualified person" defined
    

Sec. 8. As used in this chapter, "qualified person" means an
individual certified as a qualified person under section 10 of this
chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-9

"Representative" defined
    

Sec. 9. As used in this chapter, "representative" means a person's:
        (1) legal guardian or other court appointed representative
responsible for making health care decisions for the person;
        (2) health care representative under IC 16-36-1; or
        (3) attorney in fact for health care appointed under
IC 30-5-5-16.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-10

Certification as qualified person
    

Sec. 10. An attending physician may certify that a patient is a
qualified person if the attending physician determines, in accordance
with reasonable medical standards, that one (1) of the following
conditions is met:
        (1) The person has a terminal condition (as defined in
IC 16-36-4-5).
        (2) The person has a medical condition such that, if the person
were to suffer cardiac or pulmonary failure, resuscitation would
be unsuccessful or within a short period the person would

experience repeated cardiac or pulmonary failure resulting in
death.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-11

Execution of declaration
    

Sec. 11. (a) A person who is of sound mind and at least eighteen
(18) years of age may execute an out of hospital DNR declaration.
    (b) A person's representative may execute an out of hospital DNR
declaration for the person under this chapter only if the person is:
        (1) at least eighteen (18) years of age; and
        (2) incompetent.
    (c) An out of hospital DNR declaration must meet the following
conditions:
        (1) Be voluntary.
        (2) Be in writing.
        (3) Be signed by the person making the declaration or by
another person in the declarant's presence and at the declarant's
express direction.
        (4) Be dated.
        (5) Be signed in the presence of at least two (2) competent
witnesses.
    (d) An out of hospital DNR declaration must be issued on the
form specified in section 15 of this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-12

Issuance of DNR order
    

Sec. 12. An out of hospital DNR order:
        (1) may be issued only by the declarant's attending physician;
and
        (2) may be issued only if both of the following apply:
            (A) The attending physician has determined the patient is a
qualified person.
            (B) The patient has executed an out of hospital DNR
declaration under section 11 of this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-13

Transfer of patient to another physician
    

Sec. 13. (a) An attending physician who does not issue an out of
hospital DNR order for a patient who is a qualified person may
transfer the patient to another physician, who may issue an out of
hospital DNR order, unless:
        (1) the attending physician has reason to believe the patient's
declaration was not validly executed, or there is evidence the
patient no longer intends the declaration to be enforced; and
        (2) the patient is unable to validate the declaration.
    (b) Notwithstanding section 10 of this chapter, if an attending
physician, after reasonable investigation, does not find any other

physician willing to honor the patient's out of hospital DNR
declaration and issue an out of hospital DNR order, the attending
physician may refuse to issue an out of hospital DNR order.
    (c) If the attending physician does not transfer a patient under
subsection (a), the attending physician may attempt to ascertain the
patient's intent and attempt to determine the validity of the
declaration by consulting with any of the following individuals who
are reasonably available, willing, and competent to act:
        (1) A court appointed guardian of the patient, if one has been
appointed. This subdivision does not require the appointment of
a guardian so that a treatment decision may be made under this
section.
        (2) A person designated by the patient in writing to make a
treatment decision.
        (3) The patient's spouse.
        (4) An adult child of the patient or a majority of any adult
children of the patient who are reasonably available for
consultation.
        (5) An adult sibling of the patient or a majority of any adult
siblings of the patient who are reasonably available for
consultation.
        (6) The patient's clergy.
        (7) Another person who has firsthand knowledge of the patient's
intent.
    (d) The individuals described in subsection (c)(1) through (c)(7)
shall act in the best interest of the patient and shall follow the
patient's express or implied intent, if known.
    (e) The attending physician acting under subsection (c) shall list
the names of the individuals described in subsection (c) who were
consulted and include the information received in the patient's
medical file.
    (f) If the attending physician determines from the information
received under subsection (c) that the patient intended to execute a
valid out of hospital DNR declaration, the attending physician may:
        (1) issue an out of hospital DNR order, with the concurrence of
at least one (1) physician documented in the patient's medical
file; or
        (2) request a court to appoint a guardian for the patient to make
the consent decision on behalf of the patient.
    (g) An out of hospital DNR order must be issued on the form
specified in section 15 of this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-14

Effect of declaration during pregnancy
    

Sec. 14. An out of hospital DNR declaration and order of a
declarant known to be pregnant has no effect during the declarant's
pregnancy.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-15

Form
    

Sec. 15. An out of hospital DNR declaration and order must be in
substantially the following form:

OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION

AND ORDER
This declaration and order is effective on the date of execution and
remains in effect until the death of the declarant or revocation.

OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION

Declaration made this ____ day of __________. I, _____________,
being of sound mind and at least eighteen (18) years of age, willfully
and voluntarily make known my desires that my dying shall not be
artificially prolonged under the circumstances set forth below. I
declare:
    My attending physician has certified that I am a qualified person,
meaning that I have a terminal condition or a medical condition such
that, if I suffer cardiac or pulmonary failure, resuscitation would be
unsuccessful or within a short period I would experience repeated
cardiac or pulmonary failure resulting in death.
    I direct that, if I experience cardiac or pulmonary failure in a
location other than an acute care hospital or a health facility,
cardiopulmonary resuscitation procedures be withheld or withdrawn
and that I be permitted to die naturally. My medical care may include
any medical procedure necessary to provide me with comfort care or
to alleviate pain.
    I understand that I may revoke this out of hospital DNR
declaration at any time by a signed and dated writing, by destroying
or canceling this document, or by communicating to health care
providers at the scene the desire to revoke this declaration.
    I understand the full import of this declaration.
                    Signed___________________________________
                    Printed name______________________________
                    _________________________________________
                    City and State of Residence___________________
    The declarant is personally known to me, and I believe the
declarant to be of sound mind. I did not sign the declarant's signature
above, for, or at the direction of, the declarant. I am not a parent,
spouse, or child of the declarant. I am not entitled to any part of the
declarant's estate or directly financially responsible for the
declarant's medical care. I am competent and at least eighteen (18)
years of age.
Witness____________Printed name___________Date__________
Witness____________Printed name___________Date__________

OUT OF HOSPITAL DO NOT RESUSCITATE ORDER

    I,___________________, the attending physician of
_________________, have certified the declarant as a qualified
person to make an out of hospital DNR declaration, and I order
health care providers having actual notice of this out of hospital
DNR declaration and order not to initiate or continue
cardiopulmonary resuscitation procedures on behalf of the declarant,

unless the out of hospital DNR declaration is revoked.
                    Signed_____________________Date__________
                    Printed name______________________________
                    Medical license number_____________________
As added by P.L.148-1999, SEC.12.

IC 16-36-5-16

Copies of declaration and order
    

Sec. 16. Copies of the out of hospital DNR declaration and order
must be kept:
        (1) by the declarant's attending physician in the declarant's
medical file; and
        (2) by the declarant or the declarant's representative.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-17

Identification devices
    

Sec. 17. (a) The emergency medical services commission shall
develop an out of hospital DNR identification device that must be:
        (1) a necklace or bracelet; and
        (2) inscribed with:
            (A) the declarant's name;
            (B) the declarant's date of birth; and
            (C) the words "Do Not Resuscitate".
    (b) An out of hospital DNR identification device may be created
for a declarant only after an out of hospital DNR declaration and
order has been executed by a declarant and an attending physician.
    (c) The device developed under subsection (a) is not a substitute
for the out of hospital DNR declaration and order.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-18

Revocation
    

Sec. 18. (a) A declarant may at any time revoke an out of hospital
DNR declaration and order by any of the following:
        (1) A signed, dated writing.
        (2) Physical cancellation or destruction of the declaration and
order by the declarant or another in the declarant's presence and
at the declarant's direction.
        (3) An oral expression by the declarant of intent to revoke.
    (b) A declarant's representative may revoke an out of hospital
DNR declaration and order under this chapter only if the declarant
is incompetent.
    (c) A revocation is effective upon communication to a health care
provider.
    (d) A health care provider to whom the revocation of an out of
hospital DNR declaration and order is communicated shall
immediately notify the declarant's attending physician, if known, of
the revocation.
    (e) An attending physician notified of the revocation of an out of

hospital DNR declaration and order shall immediately:
        (1) add the revocation to the declarant's medical file, noting the
time, date, and place of revocation, if known, and the time, date,
and place that the physician was notified;
        (2) cancel the out of hospital DNR declaration and order by
entering the word "VOID" on each page of the out of hospital
DNR declaration and order in the declarant's medical file; and
        (3) notify any health care facility staff responsible for the
declarant's care of the revocation.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-19

Health care provider duties
    

Sec. 19. (a) A health care provider shall withhold or discontinue
CPR to a patient in an out of hospital location if the health care
provider has actual knowledge of:
        (1) an original or a copy of a signed out of hospital DNR
declaration and order executed by the patient; or
        (2) an out of hospital DNR identification device worn by the
patient or in the patient's possession.
    (b) A health care provider shall disregard an out of hospital DNR
declaration and order and perform CPR if:
        (1) the declarant is conscious and states a desire for
resuscitative measures;
        (2) the health care provider believes in good faith that the out of
hospital DNR declaration and order has been revoked;
        (3) the health care provider is ordered by the attending
physician to disregard the out of hospital DNR declaration and
order; or
        (4) the health care provider believes in good faith that the out of
hospital DNR declaration and order must be disregarded to
avoid verbal or physical confrontation at the scene.
    (c) A health care provider transporting a declarant shall document
on the transport form:
        (1) the presence of an out of hospital DNR declaration and
order;
        (2) the attending physician's name; and
        (3) the date the out of hospital DNR declaration and order was
signed.
    (d) An out of hospital DNR identification device must accompany
a declarant whenever the declarant is transported.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-20

Health care provider liability
    

Sec. 20. A health care provider who in good faith and in
accordance with reasonable medical standards:
        (1) participates in the withholding or withdrawal of CPR from
a declarant:
            (A) by whom an out of hospital DNR declaration and order

has been executed under this chapter; or
            (B) who has revoked an out of hospital DNR declaration and
order when the health care provider has no notice of the
revocation; or
        (2) provides CPR to a declarant:
            (A) when the health care provider has no notice of the out of
hospital DNR declaration and order; or
            (B) after a revocation of an out of hospital DNR declaration
and order;
is not subject to criminal or civil liability and may not be found to
have committed an act of unprofessional conduct.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-21

Presumption of validity
    

Sec. 21. (a) If a declarant is incompetent at the time of the
decision to withhold or withdraw CPR, an out of hospital DNR
declaration and order executed under this chapter is presumed to be
valid.
    (b) For purposes of this chapter, a health care provider may
presume in the absence of actual notice to the contrary that the
declarant was of sound mind when the out of hospital DNR
declaration and order was executed.
    (c) The fact that a declarant executed an out of hospital
declaration may not be considered as an indication of the declarant's
mental incompetency.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-22

Petition for review
    

Sec. 22. (a) A person may challenge the validity of an out of
hospital DNR declaration and order by filing a petition for review in
a court in the county in which the declarant resides.
    (b) A petition filed under subsection (a) must include the name
and address of the declarant's attending physician.
    (c) A court in which a petition is filed under subsection (a) may
declare an out of hospital DNR declaration and order void if the
court finds that the out of hospital DNR declaration and order was
executed:
        (1) when the declarant was incapacitated due to insanity, mental
illness, mental deficiency, duress, undue influence, fraud,
excessive use of drugs, confinement, or other disability;
        (2) contrary to the declarant's wishes; or
        (3) when the declarant was not a qualified person.
    (d) If a court finds that the out of hospital DNR declaration and
order is void, the court shall cause notice of the finding to be sent to
the declarant's attending physician.
    (e) Upon notice under subsection (d), the declarant's attending
physician shall follow the procedures under section 18(e) of this
chapter.

As added by P.L.148-1999, SEC.12.

IC 16-36-5-23

Effect upon life insurance policies
    

Sec. 23. (a) A death caused by the withholding or withdrawal of
CPR under this chapter does not constitute a suicide.
    (b) The execution of an out of hospital DNR declaration and order
under this chapter does not affect the sale, issuance, or terms of a life
insurance policy.
    (c) A policy of life insurance is not legally impaired or invalidated
by the execution of an out of hospital DNR declaration and order or
by the withholding or withdrawal of CPR from an insured declarant,
notwithstanding any term of the policy to the contrary.
    (d) An out of hospital DNR declaration and order may not be
considered in the establishment of insurance premiums for a
declarant.
    (e) A person may not require another person to execute an out of
hospital DNR declaration and order as a condition for being insured
for or receiving health care services.
    (f) This chapter does not impair or supersede any legal right or
legal responsibility that a person may have to effect the withholding
or withdrawal of CPR in a lawful manner.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-24

Intent of person without declaration not presumed
    

Sec. 24. This chapter does not create any presumption concerning
the intent of a person who has not executed an out of hospital DNR
declaration and order to consent to the withholding or withdrawal of
CPR if a terminal condition exists, or if a medical condition exists
such that the outcome of performing CPR would have the results
specified in section 10(2) of this chapter.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-25

Euthanasia not authorized
    

Sec. 25. This chapter does not authorize euthanasia or any
affirmative or deliberate act or omission to end life other than to
permit the natural process of dying.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-26

Effect upon chain of proximate cause
    

Sec. 26. The act of withholding or withdrawing CPR, when done
under:
        (1) an out of hospital DNR declaration and order issued under
this chapter;
        (2) a court order or decision of a court appointed guardian; or
        (3) a good faith medical decision by the attending physician that
the patient has a terminal illness;

is not an intervening force and does not affect the chain of proximate
cause between the conduct of a person that placed the patient in a
terminal condition and the patient's death.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-27

Destruction of declaration; forgery of revocation
    

Sec. 27. A person who knowingly or intentionally:
        (1) physically cancels or destroys an out of hospital DNR
declaration and order without the declarant's consent;
        (2) physically cancels or destroys an out of hospital DNR
declaration and order without the declarant's representative's
consent if the declarant is incompetent; or
        (3) falsifies or forges a revocation of another person's out of
hospital DNR declaration and order;
commits a Class B misdemeanor.
As added by P.L.148-1999, SEC.12.

IC 16-36-5-28

Deception with intent to cause withholding of CPR
    

Sec. 28. (a) A person who knowingly or intentionally:
        (1) falsifies or forges the out of hospital DNR declaration and
order of another person with intent to cause the withholding or
withdrawal of CPR; or
        (2) conceals or withholds personal knowledge of the revocation
of an out of hospital DNR declaration and order with intent to
cause the withholding or withdrawal of CPR;
commits a Class C felony.
    (b) A person who commits an offense described in this section is
subject to IC 29-1-2-12.1.
As added by P.L.148-1999, SEC.12.