News Briefs

Wisconsin adopts a new
medical "do-not-resuscitate" law

By Barry W. Szymanski

A person now can request a "do-not-resuscitate" bracelet from his or her physician, and responding emergency medical personnel will not perform CPR.

Under the new law, which became effective Jan. 18, 1997, a person requesting the do-not-resuscitate (DNR) bracelet must be at least 18, not pregnant, and have a terminal condition, a medical condition such that resuscitation would be unsuccessful or cause significant physical pain or harm outweighing the possibility of successful resuscitation.

An attending physician may issue a DNR order only if the patient requests and signs the order. This physician places the bracelet onto the patient's wrist and documents the patient's medical record.

The DNR bracelet is a clear, standard hospital-type bracelet at least 3/4 of an inch wide with the words "Do Not Resuscitate" and the State of Wisconsin seal printed in blue. The physician issuing the DNR order prints on the bracelet insert form the patient's name, address, date of birth and gender, and the physician's name, business phone number and original signature.

The do-not-resuscitate bracelet directs emergency medical technicians, first responders and emergency health-care facilities personnel not to attempt cardiopulmonary resuscitation on the person wearing the bracelet.

By law, "resuscitation" means cardiopulmonary resuscitation, including cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, or administration of cardiac resuscitation medications. However, emergency medical technicians and emergency health-care facilities personnel shall perform the Heimlich maneuver to expel an obstruction from a person's throat

What happens in an emergency?

Emergency health-care personnel must first assess the patient. If the patient is pulseless and nonbreathing, they check the patient's wrist for a DNR bracelet. If there is no bracelet on the patient's wrist, they provide the usual EMS care. If a DNR bracelet is found on the patient's wrist and the bracelet is not defaced, they will not undertake life support measures; however, they shall provide comfort care. Examples of comfort care include administration of oxygen, clearing the airway, controlling bleeding, positioning for comfort, providing emotional support, pain medication and splinting.

The DNR order shall not be followed if the patient has revoked the order, the do-not-resuscitate bracelet appears to have been tampered with or removed, or the responders know that the patient is pregnant.

How do you revoke a DNR order?

A patient may revoke a DNR order at any time by: a) expressing his or her desire to be resuscitated; or b) defacing, burning, cutting or removing the bracelet. If the patient tells the EMT, first responder or the emergency health-care facility personnel that they are revoking the DNR order, then the EMTs are to promptly remove the bracelet. The EMTs shall notify the attending physician of the revocation, and the attending physician shall record the revocation in the patient's medical record.

A request to resuscitate by the patient's family or a friend does not supersede the DNR order if the patient is wearing a valid bracelet and has not revoked the order.

What about liability?

No physician, EMT, first responder, health-care professional or emergency health-care facility may be held criminally or civilly liable, or charged with unprofessional conduct, if they withhold or withdraw resuscitation from a patient with a DNR order.

Any person who willfully conceals, defaces or damages the DNR bracelet without the wearer's consent may be fined not more than $500 or imprisoned for not more than 30 days or both. Any person who falsifies or transfers a DNR bracelet or conceals the revocation of a DNR order shall be fined not more than $10,000 or imprisoned for not more than 10 years or both. If a person coerces, threatens or intimidates an individual, causing that individual to sign a DNR order, that person shall be fined not more than $500 or imprisoned for not more than 30 days or both.

For further information about this new law, review Chapter 154 of the Wisconsin Statutes as amended by 1995 Wisconsin acts 168 and 200, and as ruled upon in the Wisconsin Administrative Code HFS Chapter 125.

Wauwatosa attorney Barry W. Szymanski's practice includes estate planning and emergency medical law.

He also serves as attorney for the Wisconsin Emergency Medical Services Association and is a certified police officer.

State Bar seeks ABA delegate candidates

The State Bar of Wisconsin seeks candidates interested in serving as State Bar representatives to the American Bar Association (ABA) House of Delegates.

The ABA House of Delegates' responsibilities include:

• establishing association policy and defining the ABA's positions on professional and public issues;
  
  
• electing the ABA's officers and board of governors after receiving nominations from the ABA's Nominating Committee;
  
  
• amending the ABA's Constitution (jointly with the ABA Assembly of Members);
  
  
• creating or disbanding association committees and sections; and
  
  
• setting membership dues (after conferring with the ABA's Board of Governors).

During their two-year term, State Bar of Wisconsin delegates are responsible for attending each House meeting, participating fully in its proceedings and discharging the House's responsibilities. The delegates also keep their constituency fully apprised of House actions and, to the extent possible, of matters pending before the House. They also assist constituent entities in presenting issues of concern for debate and action by the House.

An election of two State Bar of Wisconsin members, or in odd-numbered years one member and one member of the Young Lawyers Division, to the ABA House of Delegates will be held at the June 24, 1997, Board of Governors meeting during the Bar's annual convention.

Members interested in representing the Bar in this capacity should review Article III, Section 11, of the State Bar of Wisconsin bylaws for qualifications for election and election procedure.