24

A few months back, I watched a House episode that featured him violating a DNR order, and being taken to court for it.

A few days ago, I've come across a do-not-resuscitate t-shirt on one of the t-shirt web-sites, and trying to find the exact site for the question, it seems like a sample query will give you a complete list of pretty much all of these t-shirt websites overall.

If someone is admitted wearing such t-shirt, would it be considered a joke, or would it serve as a legal order to indeed not resuscitate?

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  • 2
    In what jurisdiction? – cpast May 26 '15 at 23:23
  • @cpast, these shops generally ship worldwide, but I guess most of them are based in the US, probably targeting the US audience (of no particular state) – cnst♦ May 26 '15 at 23:37
  • Not sure if this helps, but I used to engrave medical ID bracelets and necklaces, one time the customer gave me the paper the doctor gave them, and it included font size for DNR to be engraved at. So apparently, its pretty specific. 1/8 inche, in case care. – Dan Shaffer Nov 16 '15 at 20:19
  • Alot of it has to do with actual ignorance vs artificial ignorance. The size,shape color and design of one's shirt does not effect medical procedures of any kind in any way except for the obvious: It will take a few seconds to cut it off the body. – user4220 Jan 29 '16 at 23:44
  • Are Good Samaritan laws relevant to this question? – Justin Lardinois Jan 30 '16 at 0:09
21

I'm not a lawyer or a medical professional, but on Wikipedia's page about DNR, we see the following quote:

In the United States the documentation is especially complicated in that each state accepts different forms, and advance directives and living wills are not accepted by EMS as legally valid forms. If a patient has a living will that states the patient wishes to be DNR but does not have an appropriately filled out state sponsored form that is co-signed by a physician, EMS will attempt resuscitation.

Based on this, I would hazard the guess that you can't treat anything other than those forms as legally binding, as they even ignore a living will without that state's form.

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14

No, this would not be considered a legal order. A DNR order proper is an order issued by a medical practitioner (at least in Maryland, this is a doctor, an APRN, or a physician's assistant), and has to take an extremely specific form (either a specific state-issued form, or a specific state-issued device like a bracelet). A "DNR" shirt can't serve as a DNR order, and so EMS will ignore it.

With physicians, it's more complicated -- they have to obey your wishes whether or not you filled out the state form, and so if you clearly express a wish not to be resuscitated they will issue a DNR order. However, they can't do this unless it's clear that you're giving informed consent to the order; wearing a shirt isn't considered to show that you made an informed decision that you intended to be binding. An advance directive (specifying what care you'll want if you aren't conscious, which is the only time a DNR applies anyway) will require some way to confirm that this is really what you intend; generally, this consists of a (witnessed) signature or oral instructions to a practitioner.

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  • why is it different with the physicians? – cnst♦ May 27 '15 at 0:46
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    @cnst Physicians, NPs, and PAs (the latter two depending on the state) can issue a DNR order. EMTs cannot; they aren't allowed to evaluate whether you have given informed consent or make the decision not to perform specific treatment on their own (EMTs have no independent medical authority, and work under medical supervision in the form of approved procedures and radio communication with a doctor). Because doctors are qualified to translate your wishes into medical instructions, they have to do that; EMTs aren't qualified, so they don't. – cpast May 27 '15 at 0:55
  • @cpast: out of interest, does that mean that if you are conscious and clearly tell an EMT: "I do not wish to be treated", that they aren't allowed to decide on that basis not to treat you? For example would they force a treatment on someone who opposes it for religious or other reasons, where a physician would not do so? Or is it only when you're unconscious that "they aren't allowed to evaluate consent" applies? – Steve Jessop Sep 15 '15 at 18:59
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    @SteveJessop You're right that that doesn't seem correct; on rereading sources, it isn't quite correct. EMTs have some training on informed consent, and their standing orders (medical protocols written by a doctor) contain guidance on when a patient is and isn't capable of giving/refusing consent. However, they may well have to contact a doctor by phone or radio if refusal will kill the patient or the patient might not have capacity to make decisions, and in most places resuscitation can only be refused under a doctor's order (although some places have certain exceptions to that rule). – cpast Sep 15 '15 at 21:13
7

As an EMT, we are trained to only respect a legal document signed by the patient and his/her physician. Typically, there is a certain form approved by the state that must be filled out and signed such as a POLST.

In general, we are trained that if there is any doubt, resuscitation should be attempted. The logic is that it is better to resuscitate a patient that has a DNR than to not attempt resuscitation on a patient that does not have a valid DNR.

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-2

I would consider that if you wear a t-shirt like this as a joke, and you have the bad luck to run into a situation where resuscitation is needed, and the person in question gets the legal question wrong and doesn't resuscitate, then the legal question is quite irrelevant, because you are not able to sue them.

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  • This assumes that 1) only the person who does not resuscitate based on the shirt is able to do so and 2) that the failure to resuscitate will result in death. However, significant oxygen deprivation may result instead in brain damage and loss of income, in which case the person and/or their family or spouse might possibly be able to bring a suit in negligence, and so the legal question is not really irrelevant. – jimsug Nov 15 '15 at 13:29
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    Wrongful death lawsuits are definitely a thing. – cpast Nov 15 '15 at 17:05
  • If you wear it as a joke, and you need resuscitation, and some medical person construes it and expressing your wishes and doesn't resuscitate you, the more interesting question is whether your tee-shirt gets that person off the legal hook. – Michael Hardy Jan 30 '16 at 2:56
  • While this is a good point in general, it does not answer the question as asked. – sleske Jan 20 at 9:16

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