Easy remote physician/assistant to complete Ohio DNR?

March 6, 2021 7:12 AM

Is there a relatively fast way to get a DNR (Do Not Resuscitate) order signed in Ohio? The person does not have a primary care physician or any existing healthcare relationships. Remote highly preferred.

It does seem like a violation of ones right to medical self determination that the form has to be signed by a physician or physician's assistant, but that's the law. Is there a service that will help with this, or maybe a nonprofit that specializes in advanced directives? I don't mind paying for the visit, but it would give great peace of mind to get this taken care of without having to go to the doctor in person, initiate a clinical relationship, etc.

posted by wnissen to Health & Fitness (4 answers total)

This is a topic I have researched pretty extensively and lectured on at work; since I am in Georgia I am familiar with the laws here, but laws in Ohio should be similar (although there can be significant differences from state to state in specific situations). You don't give a lot of information so I can give you some general details on how these things work, but not everything will apply to your situation. Feel free to contact me privately with more details if you want; I'm sorry you are having to go the process of making these decisions.

To address your specific question, a physician (or NP or PA) has to write a DNR order because it is a medical order that is in the medical record. There is a specific form that can be used that will be recognized throughout the state, but that is not required. You may have found it during your research but if not it can be downloaded here. But the bottom line is that a person credentialed to write medical orders has to be involved because a DNR order is a medical order, just like ordering a hospital patient to get IV fluids at a given rate for so many hours.

The way that patients make their wishes known without having to involve a physician is by one of two mechanisms; a living will or a durable power of attorney for healthcare; in Georgia these have been combined into a form called an advance directive, but it appears this has not been done yet in Ohio and "advance directive" is used to collectively refer to living wills and durable power of attorney forms. The first option is a living will; that is a document that is completed by the patient that specifies their wishes for end of life care, potentially going into some detail. It goes into effect when a patient is unable to communicate their wishes to caregivers.

The other form is a durable healthcare power of attorney; that specifies an individual to make decisions on behalf of the patient regarding medical care. It includes options to name a back-up decision maker as well as guidance for the decision maker when making decisions on the patient's behalf. As with a living will, it only takes effect when the patient can no longer express their own wishes.

Both of these documents are online here. They do not require a lawyer or other professional to fill out and execute, but do need to be witnessed or notarized to ensure that the patient is the one authorizing them. The decision maker should have a copy in their possession in case it is needed (I am actually referring to an advance directive in which I am the decision maker for a friend as I write this). Good information specific to Ohio can be found at the Ohio Bar Association and Cleveland Clinic websites. It is also important to know that when a patient is admitted to a hospital the hospital is required to ask of they have an advance directive and if they don't the hospital should offer them the opportunity to complete one. This is the sort of thing that is usually breezed through with the rest of the admission paperwork, but if you pay attention it is a good opportunity to make your wishes known.

As a final note, in practical terms it can be hard to follow a patient's wishes if the family is not aware of them and willing to respect them. There have been a number of high profile cases in the media and cases I have seen personally in my hospital system where this has happened. So it is also very important for patients to make their wishes known to their family and discuss it with them if needed ahead of time. Not an easy conversation to have, but one that can avoid a lot of conflict and drama down the road.

I hope some of this is helpful; as you can see it is not a simple subject to summarize.
posted by TedW at 8:17 AM on March 6, 2021 [5 favorites]

This may be going into more detail than needed, but the federal law underlying much of this is the Patient Self-Determination Act.
posted by TedW at 8:29 AM on March 6, 2021

I imagine I am not the only AskMefite who has been the decision maker, but FWIW in my circumstance the doctor, nurse and I were standing over the patient in the Emergency Ward and they asked if I wanted them to perform brain surgery on an 83 year old woman who had a vessel burst while she was sleeping. It had not been discovered for hours at the nursing home and she was comatose. I asked if the doctor had read the advance directive and he said he had. I said it seemed to me this was an excellent example of where the patient did not want extraordinary efforts taken. He said I needed to "make the decision", which I did (I believe) in keeping with the patient's previous wishes recorded in the official document. She died about 9 hours later without regaining consciousness. So this is just to give a real world example of the importance of having the family follow the wishes that were made known, when the patient is unable to.
posted by forthright at 12:06 PM on March 6, 2021 [4 favorites]

You might want to call a local minute clinic and see if their telehealth services would do this. If the person is already in poor health and taking a number of medications, I would start with the pharmacy that they are already using.

For my elderly mother who lives in a care home, a DNR (in California POLST - Physician Orders for Life Saving Treatment) is much better if an ambulance is called because the caregiver or whoever else is there to support a fried who can't speak for themself, can just give them the POLST and EMTs will be required to follow the doctor's orders.
posted by metahawk at 3:00 PM on March 6, 2021