NORTH DAKOTA
DO NOT RESUSCITATE (DNR) DIRECTIVE
(Advance Health-Care Directive – Out-of-Hospital DNR Order)
[// GUIDANCE: This template is drafted to comply with current North Dakota advance-directive and emergency-medical-services (EMS) recognition requirements. Practitioners must confirm statutory citations and any Department of Health form updates before finalizing.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block (Patient, Physician/Authorized Practitioner, Witnesses/Notary)
1. DOCUMENT HEADER
1.1 Title.
North Dakota Do Not Resuscitate (DNR) Directive (the “Directive”).
1.2 Parties.
(a) “Declarant” – [FULL LEGAL NAME] (“I,” “me,” or “my”).
(b) Optional Health-Care Agent – [NAME], if appointed under separate power of attorney for health care (“Agent”).
(c) Health-Care Providers & EMS Personnel – Any physician, nurse, emergency medical responder, ambulance crew, hospital, or other health-care facility that may attend to the Declarant (“Providers”).
1.3 Recitals.
A. I am of sound mind and at least eighteen (18) years of age.
B. I desire, in advance, to direct that no cardiopulmonary resuscitation (CPR) or advanced cardiac life support be attempted in the event I experience cardiac or respiratory arrest.
C. This Directive is executed pursuant to, and intended to be valid under, the laws of the State of North Dakota governing advance health-care directives and out-of-hospital DNR orders.
1.4 Effective Date.
This Directive becomes effective immediately upon the latest date of execution indicated in Section 10 and remains in effect until revoked in accordance with Section 3.5.
1.5 Governing Law.
This Directive shall be construed in accordance with the substantive laws of the State of North Dakota (“state_healthcare_law”).
2. DEFINITIONS
For purposes of this Directive, capitalized terms have the meanings set forth below.
“Cardiopulmonary Resuscitation” or “CPR” means chest compressions, defibrillation, artificial ventilation, endotracheal intubation, administration of cardiac drugs, or any other medical procedure intended to restart or support respiration or heartbeat.
“Comfort Care” means any measure, treatment, or procedure used to alleviate pain or provide emotional support that is not intended to prolong life.
“Directive” has the meaning provided in Section 1.1.
“Do Not Resuscitate” or “DNR” means the instruction that no CPR be initiated or continued if cardiopulmonary function ceases.
“EMS” means licensed emergency medical services personnel operating under state protocols.
“Good-Faith Compliance” means compliance that is honest, reasonable, and without gross negligence or willful misconduct.
“Provider” or “Providers” has the meaning set forth in Section 1.2(c).
3. OPERATIVE PROVISIONS
3.1 DNR Order.
I hereby direct all Providers, including EMS personnel, to withhold or withdraw CPR in the event of my cardiac or respiratory arrest. All other medically indicated treatments, including Comfort Care, may be provided unless otherwise refused herein.
3.2 Optional Additional Instructions.
(a) Intubation/Ventilation: [ALLOW / DO NOT ALLOW]
(b) Artificial Nutrition & Hydration: [ALLOW / DO NOT ALLOW]
(c) Other Instruction(s): [SPECIFY OR “NONE”]
3.3 Physician/Authorized Practitioner Confirmation.
Pursuant to North Dakota EMS protocols, the attending [Physician / Advanced Practice Registered Nurse / Physician Assistant] must complete Section 10.2 to validate this out-of-hospital DNR order.
3.4 Duration.
This Directive remains in force unless and until revoked under Section 3.5.
3.5 Revocation.
(a) Method. I may revoke this Directive at any time by:
(i) Orally expressing the intent to revoke in the presence of a Provider;
(ii) Destroying the original Directive; or
(iii) Executing a subsequent written directive that expressly revokes or is materially inconsistent with this Directive.
(b) Effectiveness. Revocation is effective upon communication to any Provider. Providers acting in Good-Faith Compliance before receipt of notice of revocation incur no liability.
3.6 Notification Duties.
I request, but do not require, that any Provider who receives this Directive promptly place it in my medical record and communicate its existence to other treating Providers and EMS personnel.
4. REPRESENTATIONS & WARRANTIES
4.1 Declarant Representations.
(a) I have read and understand the consequences of executing this Directive.
(b) I am executing this Directive voluntarily and without undue influence.
4.2 Provider Reliance.
Providers may rely on the authenticity of this Directive and the signatures herein without further inquiry, unless they have actual knowledge of revocation or invalidity.
5. COVENANTS & RESTRICTIONS
5.1 Declarant Covenant.
I will provide copies of this Directive (or an authorized state DNR identification) to my Agent, primary care physician, long-term-care facility (if any), and family members to facilitate rapid recognition by EMS.
5.2 Provider Covenant.
Providers agree, by accepting a copy of this Directive, to honor its terms subject to applicable professional-practice standards and legal obligations.
6. DEFAULT & REMEDIES
[// GUIDANCE: Traditional “default” concepts are atypical for personal directives. The following section is tailored to healthcare settings.]
6.1 Failure to Honor Directive.
If a Provider fails to honor this Directive, any person lawfully authorized to act on my behalf may:
(a) Seek injunctive or declaratory relief compelling compliance; and
(b) Recover reasonable attorney’s fees and costs incurred in enforcing the Directive.
7. RISK ALLOCATION
7.1 Indemnification (Provider Protection).
I, my estate, heirs, and representatives agree to indemnify and hold harmless all Providers from any civil or criminal liability arising out of Good-Faith Compliance with this Directive or reliance on its validity.
7.2 Limitation of Liability (Good-Faith Standard).
No Provider acting in Good-Faith Compliance with this Directive shall be liable for damages alleged by any person or entity.
7.3 Insurance.
Nothing herein requires a Provider to maintain insurance beyond that required by applicable law.
7.4 Force Majeure.
Providers shall not be deemed in violation of this Directive if circumstances beyond their reasonable control (e.g., mass-casualty incident, equipment failure) render compliance impossible; however, Providers must resume compliance as soon as practicable.
8. DISPUTE RESOLUTION
8.1 Governing Law.
This Directive is governed by the laws identified in Section 1.5.
8.2 Forum Selection; Arbitration; Jury Trial.
Not applicable—medical directives are non-contractual personal instructions and are intended to be self-executing.
8.3 Injunctive Relief.
Nothing in this Section limits the right of any interested person to seek injunctive relief to enforce the health-care instructions set forth herein.
9. GENERAL PROVISIONS
9.1 Amendment.
I may amend this Directive only by a subsequent written instrument executed with the same formalities as this Directive.
9.2 Assignment.
This is a personal directive and may not be assigned.
9.3 Severability.
If any provision of this Directive is held invalid, the remaining provisions shall remain in full force and effect to the greatest extent permitted by law.
9.4 Integration.
This Directive constitutes my complete statement of intent regarding resuscitation and supersedes all prior oral or written directives on this specific subject matter.
9.5 Electronic Copies.
Photocopies, facsimiles, and valid electronic reproductions of this Directive have the same legal effect as the original.
10. EXECUTION BLOCK
[// GUIDANCE: North Dakota permits EITHER (i) two qualified adult witnesses OR (ii) acknowledgment before a notary public. Strike the inapplicable authentication method.]
10.1 DECLARANT SIGNATURE
I hereby sign my name to this Directive on this ___ day of _, 20, at _________ [City], North Dakota.
Signature of Declarant
Printed Name: _____
Date of Birth: _ / _ / _
Primary Address: ___________
10.2 PHYSICIAN / AUTHORIZED PRACTITIONER CERTIFICATION
I am the attending [Physician / APRN / PA] for the Declarant. I certify that:
1. I have discussed the medical implications of a DNR order with the Declarant (and Agent, if any); and
2. In my clinical judgment the DNR order is appropriate and consistent with the Declarant’s wishes.
Signature: _____ Date: _
Printed Name & Credentials: ____
ND License No.: ____
Primary Practice Address: ___________
10.3 OPTION A – TWO (2) WITNESSES
[Strike this Option if using notarization.]
We declare that the Declarant signed or acknowledged this Directive in our presence, appears to be of sound mind and acting voluntarily, and that (i) we are at least eighteen (18) years of age, (ii) we are not named Agent or successor Agent, (iii) we are not directly involved in providing health-care to the Declarant, and (iv) we are not related to the Declarant by blood, marriage, or adoption to a degree that would disqualify us under applicable law.
Witness #1 Signature: ____ Date: __
Printed Name: ______
Address: _______
Witness #2 Signature: ____ Date: __
Printed Name: ______
Address: _______
10.4 OPTION B – NOTARIZATION
[Strike this Option if using witnesses.]
State of North Dakota )
County of __ ) ss.
On this ___ day of _, 20, before me, the undersigned Notary Public, personally appeared ______ [Declarant], known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public for the State of North Dakota
My Commission Expires: _____
[// GUIDANCE: After execution, advise clients to (1) place a copy in the medical record of each treating facility; (2) carry the state-issued DNR wallet card or wear an approved bracelet if available; and (3) periodically review the Directive to ensure it continues to reflect the Declarant’s wishes.]