united-states health
Is “do not resuscitate” on a t-shirt a legal order?
<p>A few months back, I watched a <em>House</em> episode that featured him violating a <em>DNR</em> order, and being taken to court for it.</p>

<p>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.</p>

<p>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?</p>

<p>I'm not a lawyer or a medical professional, but on <a href="http://en.wikipedia.org/wiki/Do_not_resuscitate">Wikipedia's page about DNR</a>, we see the following quote:</p>

<blockquote>
  <p>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.</p>
</blockquote>

<p>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.</p>

<p>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.</p>

<p>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.</p>

<p>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 <a href="https://en.wikipedia.org/wiki/Physician_Orders_for_Life-Sustaining_Treatment">POLST</a>.</p>

<p>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 <em>not</em> attempt resuscitation on a patient that does <em>not</em> have a valid DNR.</p>
