Michigan Laws 333.1054 – Execution of order; form; language
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Terms Used In Michigan Laws 333.1054
- Attending physician: means the physician who has primary responsibility for the treatment and care of a declarant. See Michigan Laws 333.1052
- Declarant: means an individual who has executed a do-not-resuscitate order on his or her own behalf or on whose behalf a do-not-resuscitate order has been executed as provided in this act. See Michigan Laws 333.1052
- Fraud: Intentional deception resulting in injury to another.
- Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
- Guardian: means that term as defined in section 1104 of the estates and protected individuals code, 1998 PA 386, MCL 700. See Michigan Laws 333.1052
- identification bracelet: means a wrist bracelet that meets the requirements of section 7 and that is worn by a declarant while a do-not-resuscitate order is in effect. See Michigan Laws 333.1052
- Minor child: means an individual who is less than 18 years of age, has been diagnosed by an attending physician as having an advanced illness, and is not emancipated by operation of law as provided in section 4 of 1968 PA 293, MCL 722. See Michigan Laws 333.1052
- order: means a document executed under this act directing that, if an individual suffers cessation of both spontaneous respiration and circulation in a setting outside of a hospital, resuscitation will not be initiated. See Michigan Laws 333.1052
- Parent: means the natural or adoptive parent of a minor child who possesses legal decision-making authority as to the important decisions affecting the welfare of the minor child. See Michigan Laws 333.1052
- Patient advocate: means an individual who is designated to make medical treatment decisions for a patient under section 5506 to 5515 of the estates and protected individuals code, 1998 PA 386, MCL 700. See Michigan Laws 333.1052
- person: may extend and be applied to bodies politic and corporate, as well as to individuals. See Michigan Laws 8.3l
- Physician: means an individual who is licensed or otherwise authorized to engage in the practice of medicine or the practice of osteopathic medicine and surgery under article 15 of the public health code, MCL 333. See Michigan Laws 333.1052
- resuscitate: means perform cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, including, but not limited to, any of the following:
(i) Cardiac compression. See Michigan Laws 333.1052Ward: means that term as defined in section 1108 of the estates and protected individuals code, 1998 PA 386, MCL 700. See Michigan Laws 333.1052
A do-not-resuscitate order executed under section 3, 3a, or 3b must include, but is not limited to, the following language, and must be in substantially the following form:
| “DO-NOT-RESUSCITATE ORDER | ||||
| This do-not-resuscitate order is issued by _______________________________________, attending physician for _________________________________________. | ||||
| (Type or print declarant‘s, ward‘s, or minor child‘s name) | ||||
| Use the appropriate consent section below: | ||||
| A. DECLARANT CONSENT | ||||
| I have discussed my health status with my physician named above. I request that in the event my heart and breathing should stop, no person shall attempt to resuscitate me. This order will remain in effect until it is revoked as provided by law. Being of sound mind, I voluntarily execute this order, and I understand its full import. | ||||
| _______________________________________ | _______________ | |||
| (Declarant’s signature) | (Date) | |||
| _______________________________________ | _______________ | |||
| (Signature of person who signed for declarant, if applicable) | (Date) | |||
| _______________________________________ | ||||
| (Type or print full name) | ||||
| B. PATIENT ADVOCATE CONSENT | ||||
| I authorize that in the event the declarant’s heart and breathing should stop, no person shall attempt to resuscitate the declarant. I understand the full import of this order and assume responsibility for its execution. This order will remain in effect until it is revoked as provided by law. | ||||
| _______________________________________ | _______________ | |||
| (Patient advocate’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print patient advocate‘s name) | ||||
| C. PARENT CONSENT | ||||
| I authorize that in the event the minor child’s heart and breathing should stop, no person shall attempt to resuscitate the minor child. I understand the full import of this order and assume responsibility for its execution. This order will remain in effect until it is revoked as provided by law. | ||||
| _______________________________________ | _______________ | |||
| (Parent’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print parent‘s name) | ||||
| _______________________________________ | _______________ | |||
| (Parent’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print parent’s name) | ||||
| D. GUARDIAN CONSENT | ||||
| I authorize that in the event the ward’s heart and breathing should stop, no person shall attempt to resuscitate the ward. I understand the full import of this order and assume responsibility for its execution. This order will remain in effect until it is revoked as provided by law. | ||||
| _______________________________________ | _______________ | |||
| (Guardian’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print guardian‘s name) | ||||
| _______________________________________ | _______________ | |||
| (Physician’s signature) | (Date) | |||
| _______________________________________ | ||||
| (Type or print physician’s full name) | ||||
| ATTESTATION OF WITNESSES | ||||
| The individual who has executed this order appears to be of | ||||
| sound mind, and under no duress, fraud, or undue influence. | ||||
| Upon executing this order, the declarant has (has not)received | ||||
| an identification bracelet. | ||||
| ________________________________ | ________________________________ | |||
| (Witness signature) | (Date) | (Witness signature) | (Date) | |
| ________________________________ | ________________________________ | |||
| (Type or print witness’s name) | (Type or print witness’s name) | |||
| THIS FORM WAS PREPARED PURSUANT TO, AND IS IN COMPLIANCE WITH, THE MICHIGAN DO-NOT-RESUSCITATE PROCEDURE ACT.”. | ||||