Medical Directive - DNR

MEDICAL DIRECTIVE

COMFORT CARE / DO NOT RESUSCITATE (“DNR”) ORDER

Commonwealth of Massachusetts

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default, Revocation & Remedies
7. Risk Allocation
8. Dispute Resolution & Governing Law
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

1.1 Title and Parties
This Comfort Care / Do Not Resuscitate Directive (this “Directive”) is made by [PATIENT NAME] (“Patient”), date of birth [DOB], residing at [ADDRESS], in consultation with [AUTHORIZED CLINICIAN NAME & CREDENTIALS] (“Authorized Clinician”) pursuant to 105 MASS. CODE REGS. 170.000 (2024) and Mass. Gen. Laws ch. 201D, § 14 (2024).

1.2 Recitals
A. Patient is of sound mind, has been informed of the nature and consequences of a Do Not Resuscitate order, and voluntarily desires to forego cardiopulmonary resuscitation (“CPR”) in the event of cardiac or respiratory arrest.
B. Authorized Clinician, having evaluated Patient, concurs that a DNR order is medically appropriate.
C. The parties execute this Directive to provide clear, legally enforceable instructions to all health-care providers and EMS personnel.

1.3 Effective Date & Jurisdiction
This Directive becomes effective on [EFFECTIVE DATE] and is governed exclusively by the laws of the Commonwealth of Massachusetts.

2. DEFINITIONS

“Authorized Clinician” means a physician, nurse practitioner, or physician assistant licensed in Massachusetts who signs this Directive.
“Comfort Care” means medical interventions intended to alleviate pain or discomfort without attempting resuscitation.
“CPR” means cardiopulmonary resuscitation, advanced cardiac life support, defibrillation, or other life-sustaining interventions intended to restart or support cardiac or pulmonary function.
“EMS Personnel” means emergency medical technicians and paramedics certified under 105 MASS. CODE REGS. 170.000.
“Good-Faith Standard” means actions taken honestly, without negligence or willful misconduct, consistent with Mass. Gen. Laws ch. 201D, § 14.
“Health-Care Proxy” means any individual appointed under a valid Health Care Proxy instrument to make health-care decisions on Patient’s behalf.

3. OPERATIVE PROVISIONS

3.1 Do Not Resuscitate Order
a. Patient expressly directs that no CPR be attempted if Patient experiences cardiac or respiratory arrest.
b. All other appropriate Comfort Care measures shall be provided.

3.2 Scope of Treatment
This Directive applies in all settings (hospital, skilled nursing facility, home, ambulance, or other) and to all providers, including EMS Personnel.

3.3 Documentation Requirements
a. A copy of this Directive, or the original, shall be kept prominently in Patient’s medical record.
b. Patient [check one] ☐ will ☐ will not obtain and wear a DPH-approved DNR bracelet or necklace.
c. A photocopy or electronic facsimile of a properly executed Directive carries the same legal effect as the original.

3.4 Consideration
The mutual promises herein constitute adequate consideration.

4. REPRESENTATIONS & WARRANTIES

4.1 Patient Representations
a. Capacity: Patient affirms capacity to execute this Directive.
b. Voluntariness: Execution is voluntary and not the result of duress or undue influence.

4.2 Authorized Clinician Representations
a. Licensure: Authorized Clinician is duly licensed and in good standing in the Commonwealth of Massachusetts.
b. Medical Judgment: The DNR order is consistent with prevailing medical standards and Patient’s condition.
c. Compliance: Authorized Clinician will file or transmit this Directive in accordance with facility policy and DPH regulations.

4.3 Survival
The representations and warranties herein survive execution and remain in force until revocation per Section 6.

5. COVENANTS & RESTRICTIONS

5.1 Patient Covenants
a. Notification: Patient will provide copies of this Directive to all current and future health-care providers.
b. Update Obligation: Patient will advise providers promptly if this Directive is revoked.

5.2 Provider Covenant
Authorized Clinician shall review the Directive with Patient at significant changes in medical status.

6. DEFAULT, REVOCATION & REMEDIES

6.1 Revocation by Patient
Patient may revoke this Directive at any time by:
i. Writing “VOID” across this document or the DPH CC/DNR form;
ii. Verbally expressing the intent to revoke in the presence of a health-care provider; or
iii. Executing a superseding DNR directive or order.

6.2 Effect of Unauthorized Resuscitation
Resuscitative measures provided contrary to this Directive do not constitute revocation. Patient retains all other rights under law, including the right to withdraw or withhold other treatments.

6.3 Remedies
The parties acknowledge that (i) specific performance and injunctive relief are the primary and adequate remedies for breach, and (ii) monetary damages would be inadequate.

7. RISK ALLOCATION

7.1 Indemnification of Providers
Patient (and, if applicable, Patient’s estate) releases and agrees to indemnify and hold harmless all health-care providers and EMS Personnel who, in good-faith reliance on this Directive, withhold CPR in accordance with its terms, to the fullest extent permitted by Mass. Gen. Laws ch. 201D, § 14.

7.2 Limitation of Liability
No health-care provider or EMS Personnel acting under this Directive in good faith shall incur civil or criminal liability.

7.3 Insurance

8. DISPUTE RESOLUTION & GOVERNING LAW

8.1 Governing Law
This Directive is governed by and construed in accordance with the laws of the Commonwealth of Massachusetts, without regard to conflict-of-law principles.

8.2 Forum Selection
Because this is a health-care directive rather than a commercial contract, forum selection and arbitration are inapplicable. Any judicial proceeding shall be brought in a court of competent jurisdiction in Massachusetts.

8.3 Injunctive Relief
Nothing herein limits Patient’s or a provider’s right to seek emergency injunctive relief to enforce or challenge the Directive.

9. GENERAL PROVISIONS

9.1 Amendment
Amendments must be in writing, signed by Patient and Authorized Clinician, and compliant with 105 MASS. CODE REGS. 170.000.

9.2 Assignment
This Directive is personal to Patient and is not assignable.

9.3 Severability
If any provision is held invalid, the remaining provisions shall remain in full force to the maximum extent permissible.

9.4 Integration
This Directive constitutes the complete agreement regarding CPR and supersedes all prior inconsistent statements or documents, except a duly executed DPH CC/DNR or MOLST form, which shall control if attached.

9.5 Counterparts & Electronic Signatures
This Directive may be executed in counterparts and delivered by electronic signature, each deemed an original.

10. EXECUTION BLOCK

10.1 Patient

_______________________________________  
[PATIENT NAME]  
Date: _________________________________

10.2 Authorized Clinician

_______________________________________  
[AUTHORIZED CLINICIAN NAME & CREDENTIALS]  
License No.: ___________________________  
Facility/Practice: ______________________  
Date: __________________________________

10.3 Optional Witnesses

Witness 1:

_______________________________________  
Name: ________________________________  
Date: ________________________________

Witness 2:

_______________________________________  
Name: ________________________________  
Date: ________________________________

ATTACHMENTS

• Schedule A – Copy of Massachusetts DPH Comfort Care / DNR Verification Form (if executed separately)
• Schedule B – Copy of any valid Health Care Proxy

© [YEAR] [LAW FIRM/ATTORNEY NAME]. All rights reserved.