Last week’s column talked about Advance Directives to Physicians, Families or Surrogates, which allow a person to indicate choices about treatment in the event a person has a terminal or irreversible disease or condition. Remember that Advance Directives are documents used to help a person express their wishes about medical care. Today’s column addresses another kind of Advance Directive recognized by Texas law – Do-Not-Resuscitate Orders.

A person who executes a DNR Order directs health care professionals acting in an out-of-hospital setting to withhold any medical intervention used to initiate or continue certain life-sustaining treatment. According to the Texas Attorney General’s office, the Out-of-Hospital DNR is used most commonly when a person has a life-threatening or terminal illness and does not want assistance from a 911 emergency response. A person who has executed a valid Out-of-Hospital DNR Order can wear a DNR identification device around the neck or wrist (most people wear a DNR bracelet). The presence of a DNR identification device is conclusive evidence that the person has executed or issued a valid Out-of-Hospital DNR Order.

An Out-of-Hospital DNR Order must contain certain provisions, including a clear statement that the document is a DNR Order, the name of the person to whom it applies, and a statement by the attending physician. Keep in mind that the Out-of-Hospital DNR Order must also be signed in the presence of two witnesses who meet specific requirements. A health care provider or attorney should be able to provide information on how to properly execute the Out-of-Hospital DNR Order.

People who have serious health problems and do not wish to be resuscitated in the event of an emergency should give consideration to creating the Out-of-Hospital DNR Order. Like the other Advance Directives, the DNR Order can be created for free or for a very nominal fee. If someone changes their mind, the DNR Order can be revoked or overridden if the person is still competent to do so. More information about Texas advance directives is available from the Texas Department of Health (www.tdh.state.tx.us) and the Texas Attorney General (www.oag.state.tx.us).

This article appears in December 3 • 2004.

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