§ 1051.23. Disclosures to patient requesting out-of-hospital DNR order.
When a patient qualified under § 1051.11(a) (relating to patient qualifications to request and revoke out-of-hospital DNR order) requests an out-of-hospital DNR order, the attending physician shall disclose the following information to the patient before issuing an out-of-hospital DNR order for the patient:
(1) The diagnosed condition is a terminal condition.
(2) An out-of-hospital DNR order directs an EMS provider to withhold providing CPR to the patient in the event of the patient’s cardiac or respiratory arrest.
(3) The attending physician may also issue an out-of-hospital DNR bracelet or necklace for the patient, and that the necklace and bracelet also direct an EMS provider to withhold providing CPR in the event of the patient’s cardiac or respiratory arrest.
(4) An out-of-hospital DNR order, bracelet or necklace requested by a patient is effective only when the patient possesses and displays the order, bracelet or necklace.
(5) An out-of-hospital DNR order is not effective when the patient is in a hospital, unless an EMS provider has been dispatched to provide EMS to the patient in the hospital, but it may be possible for a DNR order to be issued for the patient in a hospital in accordance with other procedures.
(6) The patient may revoke the out-of-hospital DNR order; the patient may do so without the physician’s approval or knowledge; revocation may be accomplished by destroying or not displaying the order, bracelet or necklace, or by conveying the decision to revoke the out-of-hospital DNR order verbally or otherwise at the time the patient experiences respiratory or cardiac arrest; and neither the patient’s physical nor mental condition will be considered to void the patient’s decision to revoke the out-of-hospital DNR order if that decision is clearly communicated in some manner.
(7) The possibility exists that the EMS provider may administer CPR in the event of the patient’s cardiac or respiratory arrest if an EMS provider is uncertain regarding the validity or applicability of the out-of-hospital DNR order, bracelet or necklace.
(8) An EMS provider who complies with the patient’s out-of-hospital DNR order may provide other medical interventions to the patient to provide comfort or alleviate pain.
(9) The physician will make every reasonable effort to contact the patient to ask the patient to return the out-of-hospital DNR order, bracelet and necklace to the physician, for destruction by the physician, if the physician discovers that the diagnosis of the terminal condition was in error.
(10) If the patient is female, there are additional procedures that an EMS provider will need to follow to implement an out-of-hospital DNR order if the patient is pregnant at the time of cardiac or respiratory arrest. If the patient is pregnant or requests information regarding the additional procedures, the physician shall explain the requirements of § 1051.61 (relating to pregnant patients).
Source The provisions of this § 1051.23 amended February 6, 2004, effective February 7, 2004, 34 Pa.B. 677. Immediately preceding text appears at serial pages (294018) to (294020).
Cross References This section cited in 28 Pa. Code § 1051.24 (relating to disclosures to surrogate requesting out-of-hospital DNR order); and 28 Pa. Code § 1051.25 (relating to disclosures to patient when surrogate requests out-of-hospital DNR order).
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