Medical Directive - DNR

NEW JERSEY DO NOT RESUSCITATE (DNR) DIRECTIVE

(Out-of-Hospital Physician Order & Advance Directive)

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block (Patient, Physician, Witnesses)

I. DOCUMENT HEADER

1. Parties
   1.1. “Declarant” or “Patient”: [FULL LEGAL NAME], residing at [ADDRESS]; DOB [MM/DD/YYYY]; last four digits of SSN [###-##-####].
   1.2. “Attending Physician”: [PHYSICIAN NAME], M.D./D.O., New Jersey License No. [#####].
   1.3. “Health-Care Institution” (if applicable): [HOSPITAL / FACILITY NAME].

2. Recitals
   A. Declarant is a competent adult acting voluntarily.
   B. Declarant wishes to refuse cardiopulmonary resuscitation (“CPR”) and hereby issues a medical order consistent with New Jersey law governing advance directives and out-of-hospital DNR orders.
   C. Physician has determined that Declarant has decision-making capacity (or, if lacking, that the legally authorized surrogate has provided informed consent).
   D. This Directive is intended to be honored by Emergency Medical Services (“EMS”), hospitals, nursing facilities, and all other health-care providers in good faith reliance hereon.

3. Effective Date & Governing Law
   3.1. Effective as of [EFFECTIVE DATE] and governed exclusively by the health-care laws of the State of New Jersey (“State Health-Care Law”).

II. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below and apply equally to singular and plural forms. Alphabetical Listing:

“Advance Directive Act” – The body of New Jersey statutes regulating advance health-care directives in force on the Effective Date.
“Comfort Care” – Medical interventions intended solely for symptom relief, pain management, or maintenance of dignity, excluding life-sustaining treatment.
“CPR” – Any combination of chest compressions, electric cardioversion or defibrillation, artificial ventilation, endotracheal intubation, vasoactive drugs, or other advanced cardiac life support measures intended to revive cardiopulmonary function.
“DNR Order” – A physician order that no CPR be initiated in the event of cardiopulmonary arrest.
“EMS” – Emergency Medical Services personnel licensed or certified under New Jersey law.
“Good Faith” – Honest belief, absence of malice, and reasonable reliance upon the Directive without gross negligence.
“Qualified Witness” – An individual at least 18 years old who is not (i) related to Declarant by blood, marriage, or adoption, (ii) entitled to any portion of Declarant’s estate, or (iii) directly involved in Declarant’s medical care or financially responsible for such care.
“Revocation” – A written, oral, or physical act (e.g., tearing or defacing this Directive) by Declarant indicating intent to rescind the DNR Order.

III. OPERATIVE PROVISIONS

1. Directive Not to Resuscitate
   1.1. In the event of cardiopulmonary arrest, no CPR shall be administered to Declarant.
   1.2. Health-care providers shall instead provide Comfort Care in accordance with prevailing medical standards.

2. Scope of Medical Interventions
   2.1. Permitted: Pain control, oxygen for comfort, bleeding control, emotional support, and other palliative measures.
   2.2. Prohibited: Chest compressions, defibrillation, advanced airway management, artificial ventilation, cardiac drugs, and any invasive resuscitative procedure.

3. Physician Order for EMS Recognition
   3.1. The Attending Physician hereby issues this DNR Order for out-of-hospital settings.
   3.2. EMS personnel presented with an original, unrevoked copy (or approved bracelet/necklace) shall honor this DNR Order without the need for additional documentation.

4. Portability
   4.1. Copies, electronic images, or facsimiles are as valid as the original.
   4.2. Declarant authorizes inclusion in any State-approved electronic health-information exchange.

5. Revocation Procedure
   5.1. Declarant may revoke at any time by:
   (a) destroying this document,
   (b) making a written statement of revocation,
   (c) orally advising a health-care provider or witness, or
   (d) removing an authorized DNR bracelet/necklace.
   5.2. Upon Revocation, health-care providers shall resume full resuscitative measures unless a new order is executed.

IV. REPRESENTATIONS & WARRANTIES

1. Declarant represents and warrants that:
   1.1. Declarant is of sound mind and acts free from coercion.
   1.2. Declarant has discussed this decision with the Physician and understands its medical consequences.
   1.3. No undue influence has been exerted by any party.

2. Physician represents and warrants that:
   2.1. Physician has verified Declarant’s identity and decision-making capacity (or surrogate’s authority).
   2.2. Physician has explained the nature, risks, and alternatives to CPR, and believes Declarant (or surrogate) comprehends such information.
   2.3. This Directive complies with New Jersey statutory and regulatory requirements in effect on the Effective Date.
   2.4. Physician will promptly enter the DNR Order into Declarant’s clinical record.

V. COVENANTS & RESTRICTIONS

1. Provider Compliance
   1.1. All Provider Parties covenant to honor this Directive in Good Faith.
   1.2. If Provider doubts validity or encounters conflicting instructions, Provider shall:
   (a) administer Comfort Care,
   (b) consult the Attending Physician or on-call physician, and
   (c) document the basis for any action taken.

2. Notice Obligations
   2.1. Declarant (or surrogate) shall provide copies to health-care institutions, EMS, and any alternate physicians.
   2.2. Facilities receiving this Directive must include it prominently in the medical chart and electronic health record.

3. Prohibition on Conditional Care
   Providers shall not condition admission, treatment, or insurance coverage on execution or revocation of this Directive.

VI. DEFAULT & REMEDIES

1. Event of Default
   1.1. “Default” occurs if a Provider knowingly disregards this Directive absent legal justification.
   1.2. Cure Period: Immediate compliance is required; no cure period applies once CPR has been initiated contrary to this Directive.

2. Remedies
   2.1. Declarant (or estate) may seek injunctive and declaratory relief to enforce or uphold the Directive.
   2.2. Provider acting in Good Faith is shielded from civil or criminal liability, subject to State Health-Care Law.

VII. RISK ALLOCATION

1. Indemnification – Provider Protection
   Declarant (and Declarant’s estate) shall indemnify and hold harmless any Provider who, in Good Faith, honors this Directive against claims, costs, or damages arising from such compliance.

2. Limitation of Liability – Good Faith Standard
   No Provider shall be liable for harm allegedly resulting from either compliance with or reliance upon a revoked Directive if the Provider (i) had no actual knowledge of the Revocation and (ii) acted in Good Faith.

3. Insurance
   Providers shall maintain professional liability coverage in amounts required by New Jersey law; nothing herein expands such coverage obligations.

4. Force Majeure
   Providers shall not be deemed in breach where compliance is prevented by circumstances beyond reasonable control (e.g., natural disaster rendering Directive unavailable).

VIII. DISPUTE RESOLUTION

1. Governing Law
   This Directive and any dispute arising hereunder shall be governed by the health-care laws of the State of New Jersey.

2. Forum Selection
   The Superior Court of New Jersey, Law Division, shall have exclusive jurisdiction over enforcement or interpretation actions.

3. Arbitration & Jury Waiver
   Not applicable.

4. Injunctive Relief
   Parties acknowledge that unauthorized resuscitation may cause irreparable harm; equitable relief is therefore an appropriate remedy.

IX. GENERAL PROVISIONS

1. Amendment
   This Directive may be amended only by executing a new directive in accordance with State Health-Care Law.

2. Assignment
   Rights and duties hereunder are personal to Declarant and may not be assigned.

3. Severability
   Any invalid or unenforceable provision shall be severed; remaining provisions remain in full force.

4. Integration
   This document constitutes the entire DNR Directive, superseding all prior inconsistent oral or written statements.

5. Copies & Counterparts
   This Directive may be executed in multiple counterparts, each of which shall be deemed an original. Electronic or facsimile signatures are valid to the fullest extent permitted by law.

6. Accessibility
   Large-print or alternative formats shall be provided upon request to ensure compliance with accessibility requirements.

X. EXECUTION BLOCK

A. Patient / Declarant

I, the undersigned Declarant, hereby execute this NJ DNR Directive of my own free will.

B. Attending Physician Order

By my signature, I certify that the foregoing DNR Order is medically appropriate and issued in accordance with New Jersey law.

C. Witnesses

We declare that the Declarant signed or acknowledged this Directive in our presence and appears to be of sound mind and acting voluntarily.

D. Optional Notarization

State of New Jersey, County of ________________
Subscribed and sworn before me this ___ day of __________, 20___.

_________________________________
Notary Public Signature
My commission expires: _____________