DO NOT RESUSCITATE (DNR) DIRECTIVE
State of Ohio
[// GUIDANCE: This template is drafted for use by Ohio-licensed attorneys advising individual patients who wish to direct health-care providers not to attempt cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS). It is not a substitute for the Ohio Department of Health “DNR Order” form, but is designed to:
1. Obtain the patient’s informed, written instruction;
2. Authorize the attending physician/authorized practitioner to issue the statutory DNR Comfort Care or DNR Comfort Care–Arrest order; and
3. Provide risk-mitigating protections for health-care providers who act in good faith.
Counsel should attach a completed ODH DNR Order (or ensure one is executed immediately after this Directive) to assure EMS recognition pursuant to Ohio Admin. Code 4765-17-03.]
TABLE OF CONTENTS
- Definitions
- Operative Directives
- Representations & Warranties of the Patient
- Covenants & Continuing Obligations
- Revocation; Modification; Suspension
- Risk Allocation & Provider Protection
- Dispute Resolution & Governing Law
- General Provisions
- Execution Block
1. DEFINITIONS
For purposes of this Directive, the following terms have the meanings set forth below:
1.1 “Advanced Cardiac Life Support” or “ACLS” means invasive emergency procedures, including defibrillation, intubation, and administration of cardiac drugs, intended to restart or stabilize a heartbeat.
1.2 “Comfort Care” means any medical or nursing procedure, treatment, or medication that provides comfort, care, or pain relief without attempting to resuscitate.
1.3 “DNR Comfort Care Order” means a medical order issued pursuant to Ohio Rev. Code Ann. § 2133.22 that directs the withholding of CPR and ACLS immediately upon patient assessment while permitting all Comfort Care.
1.4 “DNR Comfort Care–Arrest Order” means a medical order issued pursuant to Ohio Rev. Code Ann. § 2133.22 that permits full treatment until the patient experiences cardiac or respiratory arrest, after which no resuscitative measures are to be initiated.
1.5 “EMS” means emergency medical services personnel as defined in Ohio Admin. Code 4765-17-01.
1.6 “Good-Faith Standard” means the immunity afforded to persons who, in good faith, act in accordance with, or contrary to, a DNR order, as provided under Ohio Rev. Code Ann. § 2133.24.
1.7 “Health-Care Provider” includes any physician, advanced practice registered nurse (“APRN”), physician assistant (“PA”), nurse, paramedic, EMT, hospital, or other facility rendering medical services.
1.8 “Patient” means the individual identified in Section 9.1 who executes this Directive.
1.9 “Practitioner” means the physician, APRN, or PA licensed in Ohio who is responsible for the Patient’s care and authorized to issue a DNR order under Ohio law.
2. OPERATIVE DIRECTIVES
2.1 Instruction Not to Resuscitate.
The Patient hereby DIRECTS that no person shall perform CPR, ACLS, defibrillation, or any other resuscitative intervention on the Patient, except as expressly permitted in Section 2.3.
2.2 Selection of DNR Protocol.
The Patient instructs the Practitioner to issue the following statutory order (check one):
☐ DNR COMFORT CARE (no resuscitation at any time)
☐ DNR COMFORT CARE – ARREST (full treatment until arrest, then no resuscitation)
2.3 Permitted Treatments.
Notwithstanding Section 2.1, all Health-Care Providers may:
a. Provide airway suctioning, oxygen, medications, or other measures solely for pain control or symptom relief;
b. Perform non-invasive comfort interventions (e.g., positioning, splinting, bleeding control); and
c. Transfer or admit the Patient to a hospital or other facility for comfort care if clinically indicated.
2.4 Authority to Complete Statutory Form.
The Patient authorizes and requests the Practitioner to complete and sign the Ohio Department of Health “DNR Order” form immediately upon or after execution of this Directive.
2.5 EMS Recognition.
The Patient will (i) keep the executed DNR Order readily available, and/or (ii) obtain and wear DNR identification (bracelet or necklace) meeting Ohio Admin. Code 4765-17-03 to assure recognition by EMS.
3. REPRESENTATIONS & WARRANTIES OF THE PATIENT
3.1 Capacity & Voluntariness.
The Patient represents that he/she is at least eighteen (18) years of age, of sound mind, and executing this Directive voluntarily, free of duress or undue influence.
3.2 Informed Consent.
The Patient acknowledges having discussed the nature and consequences of a DNR order with the Practitioner, including the potential for death should cardiac or respiratory arrest occur.
3.3 Revocation Awareness.
The Patient understands the right to revoke this Directive at any time pursuant to Section 5.
4. COVENANTS & CONTINUING OBLIGATIONS
4.1 Notification.
The Patient will notify family members, Health-Care Agents, and facilities of this Directive’s existence.
4.2 Record Maintenance.
The Patient authorizes caregivers to place copies of this Directive and the DNR Order in all relevant medical records, including electronic health records.
4.3 Updates.
The Patient agrees to execute updated documents if required by future statutory or regulatory changes.
5. REVOCATION; MODIFICATION; SUSPENSION
5.1 Revocation by Patient.
The Patient may revoke this Directive and any DNR Order at any time by any of the following:
a. A signed and dated written revocation;
b. An oral statement of intent to revoke, witnessed by two (2) adults; or
c. Physical destruction of the Directive and all copies of the DNR Order.
5.2 Automatic Suspension.
This Directive is suspended during any period in which the Patient is known to be pregnant and the fetus is viable, unless otherwise permitted by then-applicable law.
5.3 Effect of Revocation.
Upon revocation, Health-Care Providers shall resume full resuscitative measures unless a new DNR order is issued.
6. RISK ALLOCATION & PROVIDER PROTECTION
6.1 Good-Faith Immunity.
All Health-Care Providers, EMS personnel, and other persons who, in good faith, comply with or disregard this Directive or an associated DNR Order are entitled to the immunities provided in Ohio Rev. Code Ann. § 2133.24.
6.2 Indemnification.
The Patient agrees to indemnify and hold harmless any Health-Care Provider who, in good faith and in accordance with this Directive or any DNR Order, withholds CPR or ACLS. The indemnity shall be limited to actual damages and shall not exceed amounts recoverable under any applicable professional liability insurance.
6.3 No Punitive or Exemplary Damages.
In connection with acts or omissions taken in good-faith reliance on this Directive, the Patient waives, to the fullest extent permitted by law, any claim for punitive, exemplary, or noneconomic damages against Health-Care Providers.
7. DISPUTE RESOLUTION & GOVERNING LAW
7.1 Governing Law.
This Directive is governed by, and construed in accordance with, the laws of the State of Ohio, without regard to its conflict-of-laws principles.
7.2 Venue.
Any action arising out of or relating to this Directive shall be brought exclusively in a court of competent jurisdiction located in the county where the Patient resides or is receiving care.
7.3 Injunctive Relief.
Because damages would be an inadequate remedy for breach of this Directive, specific performance or injunctive relief may be sought to enforce its terms.
[// GUIDANCE: Arbitration, jury-waiver, and similar contract remedies are generally inappropriate for a DNR directive and therefore omitted.]
8. GENERAL PROVISIONS
8.1 Severability.
If any provision of this Directive is held invalid or unenforceable, the remaining provisions shall remain in full force, and the invalid provision shall be interpreted to fulfill its intended purpose to the maximum lawful extent.
8.2 Entire Agreement.
This Directive, together with any attached statutory DNR Order, constitutes the entire directive of the Patient regarding resuscitation and supersedes all prior oral or written statements on the subject.
8.3 Amendment.
This Directive may be amended only by a subsequently dated written instrument executed in accordance with Ohio law.
8.4 Counterparts; Electronic Signatures.
This Directive may be executed in counterparts, each of which shall be deemed an original. Electronic, facsimile, and scanned signatures shall be deemed originals for all purposes.
9. EXECUTION BLOCK
9.1 Patient
| Full Legal Name: | [PATIENT NAME] |
| Date of Birth: | [MM/DD/YYYY] |
| Address: | [STREET, CITY, STATE ZIP] |
| Phone / Email: | [CONTACT INFO] |
PATIENT SIGNATURE
I affirm the foregoing Directive on the date set forth below.
Signature: ____
Date: ___
9.2 Practitioner
I am the Practitioner responsible for the Patient’s care. I have reviewed this Directive with the Patient, and I will complete and execute the Ohio Department of Health “DNR Order” in accordance with the Patient’s selection under Section 2.2.
| Name & Credentials: | [PHYSICIAN/APRN/PA NAME] |
| Ohio License No.: | [LICENSE #] |
| Address / Facility: | [ADDRESS] |
| Phone / Email: | [CONTACT INFO] |
Signature: ____
Date: ___
9.3 Witnesses
[// GUIDANCE: Ohio law for living wills requires two disinterested adult witnesses or a notary. Although Ohio’s DNR statute does not expressly mandate witnesses, their presence strengthens enforceability.]
We declare that the Patient signed or acknowledged this Directive in our presence, appears to be of sound mind, and is not being coerced. We are not: (i) the Patient’s attending physician/Practitioner; (ii) related to the Patient by blood, marriage, or adoption; (iii) entitled to any portion of the Patient’s estate; or (iv) owners, operators, or employees of a health-care facility where the Patient is receiving care.
| Witness # | Name & Address | Signature | Date |
|---|---|---|---|
| 1 | [WITNESS 1] | ____ | ______ |
| 2 | [WITNESS 2] | ____ | ______ |
9.4 Notary Public (Optional)
State of Ohio, County of ______
Subscribed and sworn before me on this ___ day of _, 20.
Notary Public: _____
My Commission Expires: _____
ATTACHMENT A – OHIO DNR ORDER
[// GUIDANCE: Attach completed Ohio Department of Health Form No. HEA 2347 (or successor) immediately upon execution.]
© [YEAR] [LAW FIRM / AUTHOR]. All rights reserved. This template is provided for attorney drafting purposes only and does not constitute legal advice.