SOUTH CAROLINA
DO NOT RESUSCITATE (“DNR”) DIRECTIVE & ORDER
(Non-Hospital / EMS Recognition Form)
[// GUIDANCE: This template is intentionally comprehensive so that the drafting attorney can pare back any sections that are unnecessary for a particular client. Bracketed text indicates fields to be completed or modified. All internal cross-references update automatically if your word-processor is set to do so.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title. This South Carolina Do Not Resuscitate (“DNR”) Directive & Order (this “Directive”) is executed by [Full Legal Name of Patient] (the “Patient”) on [Date].
1.2 Parties.
a. Patient: [Full Legal Name], residing at [Address].
b. Attending Physician: [Physician Name, M.D./D.O.], SC License No. [__] (the “Physician”).
c. Authorized Representative (if applicable): [Name], in the capacity of [Relationship / Authority (e.g., Health Care Agent, Court-Appointed Guardian, etc.)] (the “Representative”).
1.3 Recitals.
a. The Patient desires to decline cardiopulmonary resuscitation (“CPR”) in the event of cardiac or respiratory arrest.
b. South Carolina law recognizes a properly executed DNR order for non-hospital settings and grants civil and criminal immunity to health-care providers and emergency medical services (“EMS”) personnel who comply in good faith.
c. The parties intend this Directive to satisfy all statutory form, signing, witnessing, and EMS recognition requirements in the State of South Carolina.
1.4 Governed Law. This Directive shall be governed exclusively by the health-care laws of the State of South Carolina without regard to conflicts-of-law principles.
2. DEFINITIONS
For purposes of this Directive, the following capitalized terms have the meanings set forth below:
“Authorized Representative” – The individual authorized under South Carolina law to make health-care decisions for the Patient when the Patient lacks capacity, including but not limited to a health-care agent under a valid power of attorney, court-appointed guardian, or statutory surrogate.
“CPR” – Any medical intervention intended to restore circulatory or pulmonary function, including chest compressions, defibrillation, and pharmacologic resuscitation.
“Directive” – This South Carolina Do Not Resuscitate Directive & Order, together with any attachments, schedules, or subsequently executed amendments.
“EMS” – Emergency medical services personnel licensed or certified to provide out-of-hospital emergency care under South Carolina law.
“Good-Faith Standard” – Action taken in honest belief that it is in accordance with the Patient’s expressed wishes and applicable law, without reckless disregard or intentional misconduct.
“Physician” – The South Carolina-licensed medical doctor or doctor of osteopathic medicine who executes Section 10 of this Directive.
3. OPERATIVE PROVISIONS
3.1 DNR Instruction. The Patient (or Authorized Representative, if applicable) hereby directs that no CPR be administered in the event of cardiac or respiratory arrest, whether the arrest occurs in a facility, private residence, or public location.
3.2 Scope of Treatment Declined. The instruction in Section 3.1 applies to:
a. Chest compressions;
b. Endotracheal intubation and mechanical ventilation for resuscitative purposes;
c. Defibrillation or cardioversion;
d. Advanced cardiac life support medications intended to restart the heart or lungs.
3.3 Treatments NOT Declined. This Directive does not prohibit:
a. Palliative care for pain, dyspnea, anxiety, or other comfort measures;
b. Non-resuscitative medical interventions (e.g., antibiotics, dialysis, blood products) unless separately refused;
c. Hydration and nutrition unless expressly declined in a separate instrument.
3.4 EMS Recognition Requirements.
a. Official Form. For out-of-hospital enforcement, the Patient or Representative shall ensure that an authorized South Carolina DNR form (currently SCDHEC Form 1156 or successor form) is completed, or that an approved DNR bracelet is worn.
b. Presentation Obligation. The Patient, Representative, or on-scene caregiver must present the DNR form or bracelet to EMS personnel promptly upon arrival.
c. Revocation. The Patient or Representative may revoke this Directive at any time in any manner that communicates intent to revoke to medical personnel.
3.5 Physicians’ Orders. By signing in Section 10, the Physician converts the Patient’s instruction into a medical order enforceable by health-care facilities and EMS personnel.
4. REPRESENTATIONS & WARRANTIES
4.1 Patient/Representative Representations. The undersigned Patient or Representative represents and warrants that:
a. Capacity & Authority. He or she has legal capacity (or valid authority) to execute this Directive.
b. Voluntariness. Execution is voluntary and free of coercion.
c. Informed Decision. The implications of refusing CPR have been explained and are understood.
4.2 Physician Representations. The Physician represents and warrants that:
a. Medical Judgment. The Physician has discussed the Patient’s medical condition, prognosis, and treatment options with the Patient or Representative.
b. Compliance. The Directive complies with all applicable South Carolina requirements for a valid DNR order.
4.3 Survival. The representations and warranties in this Section survive execution and remain in effect until revocation of this Directive.
5. COVENANTS & RESTRICTIONS
5.1 Patient Covenants.
a. Display. The Patient or Representative shall keep an executed copy of this Directive readily available and, when feasible, on the Patient’s person in pre-hospital settings.
b. Notification. The Patient shall notify all treating providers and facilities of the existence of this Directive.
5.2 Provider Covenants. Health-care providers who receive a copy of this Directive shall:
a. Incorporate it into the permanent medical record;
b. Honor its terms unless and until legally revoked;
c. Document any refusal to honor and the legal basis therefor.
6. DEFAULT & REMEDIES
6.1 Events of Default. A material default occurs if any provider or facility, without legal justification, administers CPR contrary to Section 3.1.
6.2 Notice & Cure. Because CPR is time-sensitive, no cure period is practicable. Immediate compliance is required.
6.3 Remedies.
a. Equitable Relief. The Patient (or estate) may seek injunctive or declaratory relief to prevent future non-compliance.
b. Costs & Fees. A prevailing Patient or estate may recover reasonable attorneys’ fees and costs incurred to enforce this Directive.
[// GUIDANCE: South Carolina’s immunity provisions for good-faith compliance with DNR orders generally supersede civil liability. The “remedies” section is primarily deterrent and may be unenforceable against EMS personnel acting in accordance with state law.]
7. RISK ALLOCATION
7.1 Indemnification (Provider Protection). The Patient and his or her heirs and assigns shall defend, indemnify, and hold harmless any health-care provider or EMS personnel who, in good faith reliance on this Directive, withholds or withdraws CPR.
7.2 Limitation of Liability (Good-Faith Standard). No health-care provider or EMS personnel shall be liable for civil damages or subject to criminal prosecution for actions or omissions consistent with this Directive, provided such actions or omissions were taken in good faith.
7.3 Insurance. Health-care facilities shall maintain, at their sole cost, professional liability insurance in amounts required by South Carolina law.
7.4 Force Majeure. Providers are excused from non-performance under this Directive if compliance is impossible due to circumstances beyond their reasonable control (e.g., natural disaster, mass-casualty event) that render verification of the Directive impossible.
8. DISPUTE RESOLUTION
8.1 Informal Resolution. The parties shall endeavor to resolve any dispute regarding interpretation or application of this Directive through expedited consultation between the Physician, ethics committee (if available), and the Representative.
8.2 Governing Law. South Carolina substantive law governs all disputes.
8.3 Forum. Any legal action shall be brought in a court of competent jurisdiction located within the State of South Carolina.
8.4 Injunctive Relief. Because CPR involves imminent bodily intrusion, the parties acknowledge that injunctive relief is an appropriate and necessary remedy for breach or threatened breach of this Directive.
[// GUIDANCE: Arbitration, jury waiver, and forum selection are not included because the metadata designates them as “not applicable.”]
9. GENERAL PROVISIONS
9.1 Amendment & Waiver. This Directive may be amended only in writing signed by the Patient (or Representative) and the Physician. No oral waiver is valid.
9.2 Assignment. Rights and obligations hereunder are personal and may not be assigned.
9.3 Severability. If any provision is held invalid, the remaining provisions shall remain in full force to the maximum extent permitted by law.
9.4 Integration. This Directive constitutes the entire agreement concerning the Patient’s refusal of CPR and supersedes any prior inconsistent writing.
9.5 Counterparts / Electronic Signatures. This Directive may be executed in counterparts, each of which is deemed an original. Electronic signatures and facsimile copies are intended to be treated as originals.
10. EXECUTION BLOCK
[// GUIDANCE: South Carolina requires (a) the Patient or Representative signature, (b) the Physician’s order, and (c) at least one witness who is not a relative by blood, marriage, or adoption, not entitled to any portion of the Patient’s estate, and not financially responsible for the Patient’s care.]
PATIENT / REPRESENTATIVE
I, the undersigned Patient or duly Authorized Representative, hereby execute this Directive on the date written below.
| Signature of Patient / Representative | Date |
|---|---|
| _____ | __ |
| Printed Name: [____] | Capacity (if not Patient): [____] |
ATTENDING PHYSICIAN
By my signature, I hereby issue a Do Not Resuscitate medical order consistent with Section 3 and applicable South Carolina law.
| Physician Signature | Date |
|---|---|
| _____ | __ |
| Printed Name: [____], M.D./D.O. | License No.: [__] |
| Business Address: [______] |
WITNESS
I declare that I am at least eighteen (18) years of age, not related to the Patient by blood, marriage, or adoption, not entitled to any portion of the Patient’s estate, not financially responsible for the Patient’s medical care, and that the Patient (or Representative) signed or acknowledged this Directive in my presence.
| Witness Signature | Date |
|---|---|
| _____ | __ |
| Printed Name: [____] | Address: [____] |
[Optional] NOTARY PUBLIC
(Not required for statutory validity but may aid authentication.)
State of South Carolina, County of [__]
Subscribed and sworn before me on [Date].
_____
Notary Public for South Carolina
My Commission Expires: [__]
ATTACHMENT A
(OPTIONAL) SCDHEC Form 1156 or successor approved EMS DNR form—attach fully executed copy if available.
[// GUIDANCE:
1. For EMS recognition, attach or concurrently execute the current SCDHEC-approved form or provide the authorized bracelet.
2. Keep copies: (i) in the Patient’s chart; (ii) with the Representative; (iii) on the refrigerator or bedside in home settings; and (iv) with hospice or nursing-facility staff.
3. Review annually and upon any major change in medical condition or decision-making capacity.]