SOUTH DAKOTA
DO NOT RESUSCITATE (DNR) MEDICAL DIRECTIVE
(“Directive”)
[// GUIDANCE: This template is drafted to comply with current South Dakota statutory and regulatory requirements for out-of-hospital Do Not Resuscitate directives, including EMS recognition and witness formalities. Counsel should confirm that no later-enacted statute or Department of Health rule has altered execution requirements before finalizing for a client.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Revocation; Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
I. DOCUMENT HEADER
-
Parties
1.1 Principal / Patient: [PATIENT FULL LEGAL NAME], residing at [ADDRESS], (“Patient”).
1.2 Authorized Health-Care Provider: [NAME & TITLE OF PHYSICIAN / APRN / PA] (“Provider”). -
Effective Date & Jurisdiction
This Directive is effective upon execution (“Effective Date”) and shall be interpreted, governed, and enforced exclusively under the laws of the State of South Dakota. -
Recitals
A. Patient is an adult of sound mind and voluntarily desires to direct the withholding of cardiopulmonary resuscitation (CPR) in the event of respiratory or cardiac arrest.
B. Patient understands the nature and consequences of executing this Directive and does so free of duress or undue influence.
C. Provider has explained, and Patient understands, the medical implications of a DNR order.
II. DEFINITIONS
For purposes of this Directive, the following terms have the meanings set forth below (alphabetically arranged):
“CPR” means cardiopulmonary resuscitation, including chest compressions, artificial ventilation, defibrillation, cardiotonic drugs, or other advanced life-support interventions intended to restart or sustain cardiac or pulmonary function.
“Designated Agent” means the individual, if any, appointed by the Patient under a separate durable power of attorney for health care to make health-care decisions when the Patient lacks decision-making capacity.
“DNR Identification” means any officially issued bracelet, necklace, wallet card, or other portable indicator recognized by South Dakota Emergency Medical Services (“EMS”) as evidencing the existence of a valid DNR order.
“Emergency Medical Services (EMS)” includes all licensed ground and air ambulance services, paramedics, emergency medical technicians, and first responders operating under South Dakota law.
“Good-Faith Compliance” means the reasonable, honest, and non-negligent reliance by any person on the validity of this Directive.
“Palliative Care” means medical or comfort care provided to alleviate pain or distress without attempting to reverse underlying causes of cardiac or respiratory arrest.
“Provider” has the meaning assigned in Section I.1.2 and includes the Provider’s authorized delegates acting within the scope of their licensure.
III. OPERATIVE PROVISIONS
3.1 Directive to Withhold Resuscitation
The Patient hereby directs that no CPR or other resuscitative measures be attempted if the Patient experiences cardiac or respiratory arrest after the Effective Date.
3.2 Affirmative Authorization
The Patient expressly authorizes and instructs all health-care providers and EMS personnel, acting within their lawful scope of practice, to withhold CPR in accordance with this Directive.
3.3 Scope of Directive
(a) Covered Interventions. Interventions specifically refused include, without limitation: chest compressions, positive-pressure ventilation, endotracheal intubation, defibrillation, cardiac or vasoactive drug administration, and any other advanced cardiac life support measures.
(b) Excluded Care. This Directive does not prohibit:
i. Palliative Care, comfort measures, or pain relief;
ii. Heimlich maneuver or basic airway clearance in the event of choking;
iii. Control of external bleeding;
iv. Administration of oxygen for comfort.
3.4 Portability; EMS Recognition
This Directive is intended to be honored in any setting, including but not limited to hospitals, long-term care facilities, ambulances, and the Patient’s residence. Patient will maintain a readily visible original or DNR Identification when feasible.
3.5 Consideration
Sufficient consideration exists by virtue of the mutual promises and undertakings herein and the statutory authority granted to the Patient to issue this Directive.
IV. REPRESENTATIONS & WARRANTIES
4.1 Patient Representations
(a) Age & Capacity. Patient is at least 18 years of age and has decision-making capacity.
(b) Voluntariness. Execution is voluntary and not conditioned on payment or receipt of any benefit.
(c) Information. Patient has received, reviewed, and understands information regarding the consequences of a DNR order.
4.2 Provider Representation
Provider confirms that the Patient appears to possess decision-making capacity and that Provider has counseled Patient on alternatives and implications of a DNR order.
4.3 Witness Representations (see Execution Block)
Each witness attests that the Patient appeared to be of sound mind, signed the Directive willingly, and was not subject to fraud, coercion, or duress.
4.4 Survival
Representations in this Section survive the Patient’s incapacity and remain effective unless this Directive is revoked pursuant to Section VI.
V. COVENANTS & RESTRICTIONS
5.1 Maintenance of Original
Patient covenants to keep the executed original of this Directive in a conspicuous and accessible location and to provide copies to the Provider, Designated Agent, and primary caregivers.
5.2 Notification Obligation
Patient (or Designated Agent) shall notify all future treating providers of the existence of this Directive and shall present DNR Identification where feasible.
5.3 Provider Filing
Provider shall, in accordance with prevailing professional standards, place a copy of this Directive (or associated medical order) in the Patient’s medical record and ensure inclusion in any statewide electronic registry when available.
VI. REVOCATION; DEFAULT & REMEDIES
6.1 Revocation by Patient
This Directive may be revoked at any time by:
(a) a signed and dated writing;
(b) oral expression of intent to revoke in the presence of a Provider or EMS personnel; or
(c) physical destruction of the Directive or DNR Identification by the Patient or by another at the Patient’s direction.
6.2 Effect of Revocation
Upon revocation, all health-care providers and EMS personnel are authorized and directed to disregard this Directive and provide full resuscitative efforts consistent with then-applicable standards of care.
6.3 Remedies for Non-Compliance
(a) Equitable Relief. Because damages are inadequate, any party may seek injunctive or declaratory relief to enforce or invalidate this Directive as circumstances warrant.
(b) Costs & Fees. A prevailing party in any enforcement action may recover reasonable attorneys’ fees and costs incurred.
VII. RISK ALLOCATION
7.1 Indemnification – Provider Protection
Patient agrees to indemnify and hold harmless Provider and any EMS personnel from civil or criminal liability for Good-Faith Compliance with this Directive, except to the extent such liability results from willful misconduct or gross negligence.
7.2 Limitation of Liability
Any person who, in Good-Faith Compliance, withholds or withdraws CPR based on this Directive shall not be liable for damages in an amount exceeding the limits, if any, established under applicable South Dakota law for good-faith medical decision making.
7.3 Force Majeure
Neither Provider nor EMS personnel shall be deemed in breach of this Directive when prevented from honoring it due to extraordinary circumstances beyond their reasonable control (e.g., mass-casualty event, disaster triage protocols).
VIII. DISPUTE RESOLUTION
8.1 Governing Law
This Directive is governed exclusively by the laws of the State of South Dakota.
8.2 Forum Selection
Any action or proceeding arising out of or relating to this Directive shall be brought in a court of competent jurisdiction located within the State of South Dakota.
8.3 Injunctive Relief
Nothing in this Section shall limit any party’s right to seek temporary or permanent injunctive relief necessary to prevent irreparable harm.
[// GUIDANCE: Arbitration and jury waiver provisions are intentionally omitted because they are typically inapplicable to advance directives and may conflict with public-policy interests in expedient judicial review.]
IX. GENERAL PROVISIONS
9.1 Amendment
Subject to statutory requirements, this Directive may be amended only by a written instrument executed with the same formalities as this Directive.
9.2 Assignment
Neither this Directive nor any rights hereunder may be assigned by any party, except as expressly permitted by law.
9.3 Severability
If any provision of this Directive is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.
9.4 Entire Agreement
This Directive constitutes the entire understanding of the parties regarding the subject matter and supersedes all prior oral or written directives concerning resuscitative measures.
9.5 Copies; Electronic Signatures
Photocopies, facsimiles, or electronically transmitted copies of this executed Directive shall be as effective as the original. Electronic signatures meeting South Dakota legal standards are accepted.
X. EXECUTION BLOCK
[// GUIDANCE: South Dakota requires TWO adult witnesses OR notarization for out-of-hospital directives to be EMS-valid. This template provides for both witnesses and notarization to maximize enforceability; counsel may delete the notary acknowledgment if electing the witness-only method.]
10.1 Patient Signature
I, the undersigned Patient, declare under penalty of perjury that I am fully informed as to the contents of this Directive and that I voluntarily execute it on the date set forth below.
| Date | Patient Signature | Printed Name |
|---|---|---|
| [DATE] | ______ | [PATIENT NAME] |
10.2 Witness Attestation
We declare that (i) the Patient signed or acknowledged signing this Directive in our presence; (ii) we are at least eighteen (18) years of age; (iii) we are not related to the Patient by blood, marriage, or adoption; (iv) we are not entitled to any portion of the Patient’s estate; (v) we are not directly involved in the Patient’s health-care; and (vi) we are not financially responsible for the Patient’s medical care.
| Witness No. | Signature | Printed Name | Address | Date |
|---|---|---|---|---|
| 1 | ______ | ____ | ____ | ____ |
| 2 | ______ | ____ | ____ | ____ |
10.3 Provider Confirmation & Medical Order (For EMS Recognition)
I confirm that I have reviewed this Directive with the Patient (or Designated Agent) and, consistent with my professional judgment, enter a corresponding Out-of-Hospital DNR Order effective as of the date below.
| Date & Time | Provider Signature | Printed Name & Title | License No. |
|---|---|---|---|
| _____ | ______ | ______ | _____ |
10.4 Notary Acknowledgment (Optional but recommended)
State of South Dakota
County of ____
On this _ day of _, 20, before me, the undersigned Notary Public, personally appeared _________, known to me or satisfactorily proven to be the individual 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
My Commission Expires: _______
[// GUIDANCE:
1. Advise Patient to distribute copies to primary care physician, local EMS agency, and family.
2. Recommend issuance of an official state-approved DNR bracelet or necklace for immediate EMS recognition.
3. Encourage annual review to confirm continued intent, especially after a major change in health status.]