CHAPTER 5. OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATIONS
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 ofcardiopulmonary resuscitation, including:
(1) cardiac compression;
(2) endotracheal intubation and other advanced airwaymanagement;
(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 similarprocedure 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 aperson at least eighteen (18) years of age who is not:
(1) the person who signed an out of hospital DNR declarationon 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 medicalcare.
For purposes of subdivision (3), a person is not considered to beentitled to any part of the declarant's estate solely by virtue of beingnominated as a personal representative or as the attorney for theestate 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 undersection 11(a) of this chapter; or
(2) for whom a representative has executed an out of hospitalDNR declaration under section 11(b) of this chapter;
and for whom an out of hospital DNR order has been written undersection 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 alocation 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 declarationand order" means a document executed under sections 11 and 12 ofthis 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 DNRidentification device" means a device developed by the emergencymedical 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 anindividual certified as a qualified person under section 10 of thischapter.
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 representativeresponsible 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 underIC 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 aqualified person if the attending physician determines, in accordancewith reasonable medical standards, that one (1) of the followingconditions is met:
(1) The person has a terminal condition (as defined inIC 16-36-4-5).
(2) The person has a medical condition such that, if the personwere to suffer cardiac or pulmonary failure, resuscitation wouldbe unsuccessful or within a short period the person would
experience repeated cardiac or pulmonary failure resulting indeath.
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 DNRdeclaration 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 followingconditions:
(1) Be voluntary.
(2) Be in writing.
(3) Be signed by the person making the declaration or byanother person in the declarant's presence and at the declarant'sexpress direction.
(4) Be dated.
(5) Be signed in the presence of at least two (2) competentwitnesses.
(d) An out of hospital DNR declaration must be issued on theform 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 aqualified person.
(B) The patient has executed an out of hospital DNRdeclaration 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 ofhospital DNR order for a patient who is a qualified person maytransfer the patient to another physician, who may issue an out ofhospital DNR order, unless:
(1) the attending physician has reason to believe the patient'sdeclaration was not validly executed, or there is evidence thepatient 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 attendingphysician, after reasonable investigation, does not find any other
physician willing to honor the patient's out of hospital DNRdeclaration and issue an out of hospital DNR order, the attendingphysician may refuse to issue an out of hospital DNR order.
(c) If the attending physician does not transfer a patient undersubsection (a), the attending physician may attempt to ascertain thepatient's intent and attempt to determine the validity of thedeclaration by consulting with any of the following individuals whoare reasonably available, willing, and competent to act:
(1) A court appointed guardian of the patient, if one has beenappointed. This subdivision does not require the appointment ofa guardian so that a treatment decision may be made under thissection.
(2) A person designated by the patient in writing to make atreatment decision.
(3) The patient's spouse.
(4) An adult child of the patient or a majority of any adultchildren of the patient who are reasonably available forconsultation.
(5) An adult sibling of the patient or a majority of any adultsiblings of the patient who are reasonably available forconsultation.
(6) The patient's clergy.
(7) Another person who has firsthand knowledge of the patient'sintent.
(d) The individuals described in subsection (c)(1) through (c)(7)shall act in the best interest of the patient and shall follow thepatient's express or implied intent, if known.
(e) The attending physician acting under subsection (c) shall listthe names of the individuals described in subsection (c) who wereconsulted and include the information received in the patient'smedical file.
(f) If the attending physician determines from the informationreceived under subsection (c) that the patient intended to execute avalid out of hospital DNR declaration, the attending physician may:
(1) issue an out of hospital DNR order, with the concurrence ofat least one (1) physician documented in the patient's medicalfile; or
(2) request a court to appoint a guardian for the patient to makethe consent decision on behalf of the patient.
(g) An out of hospital DNR order must be issued on the formspecified 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 adeclarant known to be pregnant has no effect during the declarant'spregnancy.
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 insubstantially the following form:
OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION
AND ORDERThis declaration and order is effective on the date of execution andremains 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, willfullyand voluntarily make known my desires that my dying shall not beartificially prolonged under the circumstances set forth below. Ideclare:
My attending physician has certified that I am a qualified person,meaning that I have a terminal condition or a medical condition suchthat, if I suffer cardiac or pulmonary failure, resuscitation would beunsuccessful or within a short period I would experience repeatedcardiac or pulmonary failure resulting in death.
I direct that, if I experience cardiac or pulmonary failure in alocation other than an acute care hospital or a health facility,cardiopulmonary resuscitation procedures be withheld or withdrawnand that I be permitted to die naturally. My medical care may includeany medical procedure necessary to provide me with comfort care orto alleviate pain.
I understand that I may revoke this out of hospital DNRdeclaration at any time by a signed and dated writing, by destroyingor canceling this document, or by communicating to health careproviders 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 thedeclarant to be of sound mind. I did not sign the declarant's signatureabove, 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 thedeclarant's estate or directly financially responsible for thedeclarant'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 qualifiedperson to make an out of hospital DNR declaration, and I orderhealth care providers having actual notice of this out of hospitalDNR declaration and order not to initiate or continuecardiopulmonary 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 ordermust be kept:
(1) by the declarant's attending physician in the declarant'smedical 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 shalldevelop 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 createdfor a declarant only after an out of hospital DNR declaration andorder has been executed by a declarant and an attending physician.
(c) The device developed under subsection (a) is not a substitutefor 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 hospitalDNR declaration and order by any of the following:
(1) A signed, dated writing.
(2) Physical cancellation or destruction of the declaration andorder by the declarant or another in the declarant's presence andat 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 hospitalDNR declaration and order under this chapter only if the declarantis incompetent.
(c) A revocation is effective upon communication to a health careprovider.
(d) A health care provider to whom the revocation of an out ofhospital DNR declaration and order is communicated shallimmediately notify the declarant's attending physician, if known, ofthe 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 thetime, 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 byentering the word "VOID" on each page of the out of hospitalDNR declaration and order in the declarant's medical file; and
(3) notify any health care facility staff responsible for thedeclarant'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 discontinueCPR to a patient in an out of hospital location if the health careprovider has actual knowledge of:
(1) an original or a copy of a signed out of hospital DNRdeclaration and order executed by the patient; or
(2) an out of hospital DNR identification device worn by thepatient or in the patient's possession.
(b) A health care provider shall disregard an out of hospital DNRdeclaration and order and perform CPR if:
(1) the declarant is conscious and states a desire forresuscitative measures;
(2) the health care provider believes in good faith that the out ofhospital DNR declaration and order has been revoked;
(3) the health care provider is ordered by the attendingphysician to disregard the out of hospital DNR declaration andorder; or
(4) the health care provider believes in good faith that the out ofhospital DNR declaration and order must be disregarded toavoid verbal or physical confrontation at the scene.
(c) A health care provider transporting a declarant shall documenton the transport form:
(1) the presence of an out of hospital DNR declaration andorder;
(2) the attending physician's name; and
(3) the date the out of hospital DNR declaration and order wassigned.
(d) An out of hospital DNR identification device must accompanya 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 inaccordance with reasonable medical standards:
(1) participates in the withholding or withdrawal of CPR froma 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 andorder when the health care provider has no notice of therevocation; or
(2) provides CPR to a declarant:
(A) when the health care provider has no notice of the out ofhospital DNR declaration and order; or
(B) after a revocation of an out of hospital DNR declarationand order;
is not subject to criminal or civil liability and may not be found tohave 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 thedecision to withhold or withdraw CPR, an out of hospital DNRdeclaration and order executed under this chapter is presumed to bevalid.
(b) For purposes of this chapter, a health care provider maypresume in the absence of actual notice to the contrary that thedeclarant was of sound mind when the out of hospital DNRdeclaration and order was executed.
(c) The fact that a declarant executed an out of hospitaldeclaration may not be considered as an indication of the declarant'smental 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 ofhospital DNR declaration and order by filing a petition for review ina court in the county in which the declarant resides.
(b) A petition filed under subsection (a) must include the nameand address of the declarant's attending physician.
(c) A court in which a petition is filed under subsection (a) maydeclare an out of hospital DNR declaration and order void if thecourt finds that the out of hospital DNR declaration and order wasexecuted:
(1) when the declarant was incapacitated due to insanity, mentalillness, 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 andorder is void, the court shall cause notice of the finding to be sent tothe declarant's attending physician.
(e) Upon notice under subsection (d), the declarant's attendingphysician shall follow the procedures under section 18(e) of thischapter.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 ofCPR under this chapter does not constitute a suicide.
(b) The execution of an out of hospital DNR declaration and orderunder this chapter does not affect the sale, issuance, or terms of a lifeinsurance policy.
(c) A policy of life insurance is not legally impaired or invalidatedby the execution of an out of hospital DNR declaration and order orby 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 beconsidered in the establishment of insurance premiums for adeclarant.
(e) A person may not require another person to execute an out ofhospital DNR declaration and order as a condition for being insuredfor or receiving health care services.
(f) This chapter does not impair or supersede any legal right orlegal responsibility that a person may have to effect the withholdingor 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 concerningthe intent of a person who has not executed an out of hospital DNRdeclaration and order to consent to the withholding or withdrawal ofCPR if a terminal condition exists, or if a medical condition existssuch that the outcome of performing CPR would have the resultsspecified 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 anyaffirmative or deliberate act or omission to end life other than topermit 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 doneunder:
(1) an out of hospital DNR declaration and order issued underthis chapter;
(2) a court order or decision of a court appointed guardian; or
(3) a good faith medical decision by the attending physician thatthe patient has a terminal illness;is not an intervening force and does not affect the chain of proximatecause between the conduct of a person that placed the patient in aterminal 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 DNRdeclaration and order without the declarant's consent;
(2) physically cancels or destroys an out of hospital DNRdeclaration and order without the declarant's representative'sconsent if the declarant is incompetent; or
(3) falsifies or forges a revocation of another person's out ofhospital 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 andorder of another person with intent to cause the withholding orwithdrawal of CPR; or
(2) conceals or withholds personal knowledge of the revocationof an out of hospital DNR declaration and order with intent tocause the withholding or withdrawal of CPR;
commits a Class C felony.
(b) A person who commits an offense described in this section issubject to IC 29-1-2-12.1.
As added by P.L.148-1999, SEC.12.