Medical Directive - DNR

MISSISSIPPI OUT-OF-HOSPITAL

DO-NOT-RESUSCITATE (DNR) DIRECTIVE

(Pursuant to the Mississippi Uniform Health-Care Decisions Act, Miss. Code Ann. § 41-41-201 et seq., and all other applicable Mississippi statutes and regulations governing Out-of-Hospital DNR Orders)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block
11. EMS Recognition & Wallet Card (Optional)

1. DOCUMENT HEADER

1.1 Title. Mississippi Out-of-Hospital Do-Not-Resuscitate (DNR) Directive (the “Directive”).

1.2 Declarant. [FULL LEGAL NAME OF DECLARANT], an individual of sound mind (the “Declarant”).

1.3 Effective Date. This Directive becomes effective on the date signed by the Declarant (the “Effective Date”).

1.4 Governing Law. This Directive shall be interpreted and enforced in accordance with the laws of the State of Mississippi, without regard to conflict-of-law principles.

1.5 Purpose & Consideration. Declarant executes this Directive to instruct all health-care providers, facilities, and emergency medical services (“EMS”) personnel to withhold resuscitative measures in accordance with the Declarant’s expressed wishes and Mississippi law. No monetary consideration is exchanged.

2. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below. Undefined capitalized terms shall be interpreted according to customary medical and legal usage in Mississippi.

“CPR” means cardiopulmonary resuscitation, including chest compressions, artificial ventilation, defibrillation, cardiac drugs, or other related procedures.

“DNRO” means a written Do-Not-Resuscitate Order completed and signed by the Declarant’s Attending Physician on the form prescribed or approved by the Mississippi State Department of Health.

“EMS Personnel” means emergency medical technicians, paramedics, first responders, and any other individuals licensed or certified to provide pre-hospital emergency medical services under Mississippi law.

“Good Faith” means honest belief, without malice or the intent to defraud, and with reasonable medical judgment consistent with generally accepted standards of medical practice.

“Health-Care Provider” or “Provider” means any individual or facility authorized by law to administer health care, including physicians, hospitals, nursing facilities, hospice programs, home health agencies, and EMS Personnel.

“Resuscitative Measures” means CPR and any advanced life-support interventions intended to restore or sustain cardiopulmonary function after cardiac or respiratory arrest.

3. OPERATIVE PROVISIONS

3.1 Instruction to Withhold Resuscitation.
(a) The Declarant expressly directs all Health-Care Providers and EMS Personnel to withhold, withdraw, and/or not initiate Resuscitative Measures in the event of the Declarant’s cardiac or respiratory arrest.
(b) The Declarant understands that this instruction may result in death.

3.2 Scope of Treatment Allowed. Except for Resuscitative Measures, the Declarant authorizes all other medically indicated or comfort-focused treatments, including but not limited to pain management, palliative care, or nutrition and hydration, unless separately refused in writing.

3.3 DNRO Requirement. The Declarant authorizes and requests [ATTENDING PHYSICIAN NAME] (the “Physician”) to execute a DNRO consistent with this Directive. The DNRO shall be attached hereto as Schedule A once executed.

3.4 Revocation.
(a) The Declarant may revoke this Directive at any time by oral or written statement, physical destruction, or by any other act evidencing the intent to revoke.
(b) Revocation is effective immediately upon communication to any Health-Care Provider or EMS Personnel.

3.5 Prior Directives Superseded. All prior DNR directives or inconsistent advance health-care directives executed by the Declarant are hereby revoked in their entirety.

3.6 Distribution. The Declarant shall provide copies of this Directive and any DNRO to:
(i) the Physician;
(ii) primary Health-Care Providers;
(iii) closest family members and/or health-care decision makers; and
(iv) EMS Personnel as needed.

4. REPRESENTATIONS & WARRANTIES

4.1 Declarant. The Declarant represents and warrants that:
(a) Declarant is at least eighteen (18) years of age and of sound mind;
(b) Execution of this Directive is voluntary and not the result of duress or undue influence; and
(c) Declarant has been advised of the medical consequences of signing this Directive.

4.2 Physician. The Physician (upon signature of the DNRO) represents and warrants that, in Good Faith, the Physician:
(a) finds the declarant competent at the time of execution;
(b) has explained the medical implications of a DNR order; and
(c) will record the existence of this Directive in the Declarant’s medical record.

4.3 Survival. The representations and warranties in this Section 4 shall survive the Declarant’s death to the extent necessary to enforce Provider immunity and other protections afforded herein.

5. COVENANTS & RESTRICTIONS

5.1 Declarant Covenants. The Declarant shall:
(a) maintain custody of the original Directive or ensure its availability at the Declarant’s residence or facility; and
(b) notify the Physician promptly upon revocation or any material change in health status affecting the Directive.

5.2 Provider Covenants. Health-Care Providers and EMS Personnel who are presented with a valid, unrevoked Directive or DNRO shall:
(a) comply with its terms in Good Faith; and
(b) document compliance or any refusal in accordance with professional standards and Mississippi law.

5.3 Limitations. This Directive does not authorize euthanasia, assisted suicide, or any affirmative act to end life other than withholding Resuscitative Measures expressly elected herein.

6. DEFAULT & REMEDIES

6.1 Material Breach. Failure of any Provider to honor this Directive after receipt constitutes a material breach of the Provider’s statutory duties.

6.2 Notice & Cure. If time and patient condition permit, any Provider uncertain of the Directive’s validity must immediately consult:
(a) the Physician,
(b) the Declarant (if competent), or
(c) the Declarant’s legally authorized representative.

6.3 Remedies.
(a) Equitable Relief. Because monetary damages are inadequate, the Declarant and/or the Declarant’s representative may seek injunctive or declaratory relief to enforce this Directive.
(b) Attorneys’ Fees. A court may award reasonable attorneys’ fees and costs to the prevailing party enforcing this Directive.

7. RISK ALLOCATION

7.1 Indemnification. The Declarant (and the Declarant’s estate) agrees to indemnify and hold harmless any Provider who, in Good Faith reliance on this Directive or a duly executed DNRO, withholds Resuscitative Measures.

7.2 Limitation of Liability. No Provider acting in Good Faith and in substantial compliance with this Directive or an attached DNRO shall be civilly or criminally liable, nor subject to disciplinary action, for honoring or failing to honor this Directive, consistent with Miss. Code Ann. § 41-41-217.

7.3 Insurance. Providers shall maintain, if applicable, professional liability insurance in at least the minimum amounts required by Mississippi law or governing licensure bodies.

7.4 Force Majeure. Providers shall not be deemed in breach if Resuscitative Measures are provided in circumstances beyond their reasonable control (e.g., mass casualty events or equipment malfunction) where compliance is impossible.

8. DISPUTE RESOLUTION

8.1 Exclusive Governing Law. Mississippi law exclusively governs any dispute arising under or related to this Directive.

8.2 Forum Selection. Any action shall be filed in a court of competent jurisdiction in the county in Mississippi where the Declarant received care or where the facility is located.

8.3 Jury Waiver. Not applicable.

8.4 Arbitration. Not applicable.

8.5 Injunctive Relief. Nothing herein limits the right of the Declarant, the Declarant’s representative, or any Provider to seek immediate injunctive relief to enforce or clarify this Directive.

9. GENERAL PROVISIONS

9.1 Amendment & Waiver. Only the Declarant may amend this Directive, and any amendment must comply with the same execution formalities as this Directive. No waiver of any provision shall be effective unless in writing and signed by the Declarant.

9.2 Assignment. The rights and obligations under this Directive are personal and non-assignable, except that the Declarant’s lawful surrogate, agent, or personal representative may exercise any rights post-incapacity or post-mortem.

9.3 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force to the maximum extent permitted by law, and a court may reform the Directive to effectuate the Declarant’s intent.

9.4 Integration. This Directive, together with any DNRO attached hereto, constitutes the entire agreement concerning the Declarant’s instruction not to be resuscitated and supersedes all prior inconsistent directives.

9.5 Counterparts & Electronic Signatures. This Directive may be executed in counterparts, each of which is deemed an original, and signatures transmitted electronically (including via facsimile or secure PDF) are deemed original signatures for all purposes.

10. EXECUTION BLOCK

I, [DECLARANT NAME], declare that I am of sound mind, that I understand the nature and effect of this Directive, and that I sign it voluntarily on the Effective Date set forth below.

DECLARANT
__________________________________________
[DECLARANT NAME]
Date: ______________________

WITNESS ATTESTATION

(See § 41-41-205 for witness criteria. At least two witnesses, each 18 years or older; neither may be the Declarant’s health-care provider or related to the Declarant by blood, marriage, or adoption; and at least one witness must not be entitled to any portion of the Declarant’s estate.)

1. First Witness
   __________________________________________
   Name: _________________________________
   Address: _______________________________
   Date: _________________________________

2. Second Witness
   __________________________________________
   Name: _________________________________
   Address: _______________________________
   Date: _________________________________

NOTARY ACKNOWLEDGMENT (OPTIONAL BUT RECOMMENDED)

State of Mississippi )
County of ___________)

On this _____ day of _______________, 20____, before me, the undersigned notary public, personally appeared [DECLARANT NAME], who is personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.

__________________________________________
Notary Public, State of Mississippi
My Commission Expires: ________________

PHYSICIAN ORDER (DNRO) – Schedule A

(To be completed and signed by the Physician on the Mississippi-approved DNRO form.)

11. EMS RECOGNITION & WALLET CARD (OPTIONAL)

11.1 Wallet Card. A wallet-sized summary of this Directive may be printed, signed by the Declarant, and laminated. The wallet card should:
(a) display the Declarant’s full name and date of birth;
(b) state “MISSISSIPPI DO-NOT-RESUSCITATE – SEE ORIGINAL”;
(c) include the Physician’s name and phone number; and
(d) bear the Declarant’s signature and the date of execution.

11.2 Bracelet/Necklace. Declarant may obtain an approved DNR medical identification bracelet or necklace pursuant to MSDH guidelines. EMS Personnel encountering such identification shall, in Good Faith, presume the existence of a valid DNRO unless presented with information to the contrary.