State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_90 > GS_90-21_17

§ 90‑21.17.  Portable donot resuscitate order and Medical Order for Scope of Treatment.

(a)        It is the intent ofthis section to recognize a patient's desire and right to withholdcardiopulmonary resuscitation and other life‑prolonging measures to avoidloss of dignity and unnecessary pain and suffering through the use of aportable do not resuscitate ("DNR") order or a Medical Order forScope of Treatment (MOST).

This section establishes anoptional and nonexclusive procedure by which a patient or the patient'srepresentative may exercise this right.

(b)        A physician mayissue a portable DNR order or MOST for a patient:

(1)        With the consent ofthe patient;

(2)        If the patient is aminor, with the consent of the patient's parent or guardian; or

(3)        If the patient isnot a minor but is incapable of making an informed decision regarding consentfor the order, with the consent of the patient's representative.

The physician shall documentthe basis for the DNR order or MOST in the patient's medical record. When theorder is a MOST, the patient or the patient's representative must sign theform, provided, however, that if it is not practicable for the patient'srepresentative to sign the original MOST form, the patient's representativeshall sign a copy of the completed form and return it to the health careprofessional completing the form. The copy of the form with the signature ofthe patient's representative, whether in paper or electronic form, shall beplaced in the patient's medical record. When the signature of the patient'srepresentative is on a separate copy of the MOST form, the original MOST formmust indicate in the appropriate signature field that the signature is "onfile".

(c)        The Department ofHealth and Human Services shall develop a portable DNR order form and a MOSTform. The official DNR form shall include fields for the name of the patient;the name, address, and telephone number of the physician; the signature of thephysician; and other relevant information. At a minimum, the official MOST formshall include fields for: the name of the patient; an advisory that a patientis not required to have a MOST; the name, telephone number, and signature ofthe physician, physician assistant, or nurse practitioner authorizing theorder; the name and contact information of the health care professional whoprepared the form with the patient or the patient's representative; informationon who agreed (i.e., the patient or the patient's representative) to theoptions selected on the MOST form; a range of options for cardiopulmonaryresuscitation, medical interventions, antibiotics, medically administeredfluids and nutrition; patient or patient representative's name, contactinformation, and signature; effective date of the form and review dates; aprominent advisory that directions in a MOST form may suspend, while those MOSTdirections are in effect, any conflicting directions in a patient's previouslyexecuted declaration of an advance directive for a natural death ("livingwill"), health care power of attorney, or other legally authorizedinstrument; and an advisory that the MOST may be revoked by the patient or thepatient's representative. The official MOST form shall also include thefollowing statement written in boldface type directly above the signature line:"You are not required to sign this form to receive treatment." Theform may be approved by reference to a standard form that meets therequirements of this subsection. For purposes of this section, the"patient's representative" means an individual from the list ofpersons authorized to consent to the withholding of life‑prolongingmeasures pursuant to G.S. 90‑322.

(d)        No physician,emergency medical professional, hospice provider, or other health care providershall be subject to criminal prosecution, civil liability, or disciplinaryaction by any professional licensing or certification agency for withholdingcardiopulmonary resuscitation or other life‑prolonging measures from apatient in good faith reliance on an original DNR order or MOST form adoptedpursuant to subsection (c) of this section, provided that (i) there are noreasonable grounds for doubting the validity of the order or the identity ofthe patient, and (ii) the provider does not have actual knowledge of therevocation of the portable DNR order or MOST. No physician, emergency medicalprofessional, hospice provider, or other health care provider shall be subjectto criminal prosecution, civil liability, or disciplinary action by anyprofessional licensing or certification agency for failure to follow a DNRorder or MOST form adopted pursuant to subsection (c) of this section if theprovider had no actual knowledge of the existence of the DNR order or MOST.

(e)        A health carefacility may develop policies and procedures that authorize the facility'sprovider to accept a portable DNR order or MOST as if it were an order of themedical staff of that facility. This section does not prohibit a physician in ahealth care facility from issuing a written order, other than a portable DNRorder or MOST not to resuscitate a patient in the event of cardiac orrespiratory arrest, or to use, withhold, or withdraw additional medicalinterventions as provided in the MOST, in accordance with acceptable medicalpractice and the facility's policies.

(f)         Nothing in thissection shall affect the validity of portable DNR order or MOST forms inexistence prior to the effective date of this section. (2001‑445, s. 1; 2007‑502,s. 14.)