Do not resuscitate purple bracelet on top of a hospital medical form - can a guardian sign a dnr concept

In Michigan, a legal guardian has the right and responsibility to make medical decisions for an incapacitated person (ward). The guardian can, for instance, select the ward’s medical providers, consent to treatment on the ward’s behalf, and access the ward’s medical record. But what about making end-of-life decisions? Can a Michigan guardian stop doctors from giving cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest?

In short, the answer is yes: a Michigan guardian can sign a do-not-resuscitate, or DNR order (with some exceptions that we will discuss below. With that document in place, medical providers are prohibited from initiating CPR if the patient’s heart stops or the patient stops breathing.

What is a DNR?

A DNR is a medical directive which directs that “if an individual suffers cessation of both spontaneous respiration and circulation in a setting outside of a hospital, resuscitation will not be initiated.” In Michigan, a DNR must be on a specific form.

Under most circumstances, a DNR is consented to by the person to whom it applies. We speak of patients “signing a DNR,” but in reality, what they are signing is a consent to the DNR. The DNR itself is a medical order that must be signed by a doctor (after consultation with the patient) and placed in the patient’s medical file.

Many people want a DNR because they are frail or seriously ill and believe that even if they are resuscitated, they are unlikely to have a good quality of life for the time they have left. They would prefer to be allowed to die naturally without intervention than to receive a potentially painful and damaging treatment that might extend their life but also their suffering. They may also want to spare loved ones the difficulty of watching them suffer. The decision to execute a DNR is a deeply personal one and should not be made lightly.

The decision to execute a DNR is even more weighty when it is being made by a guardian on behalf of a vulnerable person. Because a guardian is obligated to act in a ward’s best interest, there are requirements in place under Michigan law to protect wards in this situation.

How Can a Guardian Sign a DNR for a Ward in Michigan?

Because the decision to put a DNR in place is so personal, every effort must be made to involve the ward in the making of the decision if possible. The guardian must personally visit the ward within 14 days before executing the DNR and must discuss the DNR with the ward, if it is possible to have meaningful communication with the ward. A guardian is also obligated to personally consult with the ward’s attending physician regarding the basis for the order. The guardian must base the decision to execute a DNR on the best interests of the ward based on this consultation

Once the DNR is executed, the guardian must provide the ward’s attending physician with a copy of the order. If the ward lives in a care facility, a copy of the DNR must be provided to the administrator of the facility; if the ward lives in a private residence, a copy of the DNR must be available in the residence.

Can All Guardians of Adult Wards in Michigan Execute a DNR?

Michigan law makes clear that guardians can be given the authority to execute a DNR on behalf of a ward, and the court creating a guardianship must grant the guardian the baseline authority to do so, after which the guardian must go through the steps listed above. However, not all guardians are granted baseline authority to execute a DNR for a ward.

For example, in a limited guardianship, a court may decide that the ward does not need for the guardian to have the power to execute a DNR, and that that power should remain with the ward. If the ward previously executed a valid patient advocate designation, the patient advocate, rather than the guardian, would have the authority to execute a DNR. Michigan law states that if a ward has a patient advocate, the guardian shall not be given any of the same powers as the patient advocate.

How Can a Guardian Make Sure First Responders Know of a Ward’s DNR?

Because the need to administer CPR arises suddenly, medical personnel may not have time to review a patient’s file or medical records to see if they contain a DNR. A guardian may arrange for a medical alert-type bracelet for the ward to wear in order to alert others to the existence of a DNR.

Is a DNR Executed By a Guardian Valid Indefinitely?

A DNR executed by a guardian on a ward’s behalf remains valid for a year. After that time, the process must repeat: the guardian must visit with the ward and meet with the ward’s attending physician in order to reaffirm the DNR for another year.

To learn more about Michigan do-not-resuscitate laws and guardianship, contact Suzanne R. Fanning PLLC to schedule a consultation.