(8) Inclusion in medical record.
Upon receipt of a declaration, a health care facility, as defined in s. 155.01 (6)
, or a health care provider, as defined in s. 155.01 (7)
, shall, if the declarant is a patient of the health care facility or health care provider, include the declaration in the medical record of the declarant.
(9) Declaration from other jurisdiction.
A valid document that authorizes the withholding or withdrawal of life-sustaining procedures or of feeding tubes and that is executed in another state or jurisdiction in compliance with the law of that state or jurisdiction is valid and enforceable in this state to the extent that the document is consistent with the laws of this state.
Filing declaration. 154.13(1)
A declarant or an individual authorized by the declarant may, for a fee, file the declarant's declaration, for safekeeping, with the register in probate of the county in which the declarant resides.
If a declarant or authorized individual has filed the declarant's declaration as specified in sub. (1)
, the following persons may have access to the declaration without first obtaining consent from the declarant:
The individual authorized by the declarant.
A health care provider who is providing care to the declarant.
The court and all parties involved in proceedings in this state for adjudication of incompetency and appointment of a guardian for the declarant, for emergency detention under s. 51.15
, for involuntary commitment under s. 51.20
, or for protective placement or protective services under ch. 55
Any person under the order of a court for good cause shown.
Failure to file a declaration under sub. (1)
creates no presumption about the intent of an individual with regard to his or her health care decisions.
History: 1991 a. 281
; 2005 a. 387
Any person who intentionally conceals, cancels, defaces, obliterates or damages the declaration of another without the declarant's consent may be fined not more than $500 or imprisoned not more than 30 days or both.
Any person who, with the intent to cause a withholding or withdrawal of life-sustaining procedures or feeding tubes contrary to the wishes of the declarant, illegally falsifies or forges the declaration of another or conceals a declaration revoked under s. 154.05 (1) (a)
or any person who intentionally withholds actual knowledge of a revocation under s. 154.05
is guilty of a Class F felony.
In this subchapter:
“Do-not-resuscitate bracelet" means a standardized identification bracelet that meets the specifications established under s. 154.27 (1)
, or that is approved by the department under s. 154.27 (2)
, that bears the inscription “Do Not Resuscitate" and signifies that the wearer is a qualified patient who has obtained a do-not-resuscitate order and that the order has not been revoked.
“Do-not-resuscitate order" means a written order issued under the requirements of this subchapter that directs emergency medical technicians, first responders and emergency health care facilities personnel not to attempt cardiopulmonary resuscitation on a person for whom the order is issued if that person suffers cardiac or respiratory arrest.
“Qualified patient" means a person who has attained the age of 18 and to whom any of the following conditions applies:
The person has a medical condition such that, were the person to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful in restoring cardiac or respiratory function or the person would experience repeated cardiac or pulmonary failure within a short period before death occurs.
The person has a medical condition such that, were the person to suffer cardiac or pulmonary failure, resuscitation of that person would cause significant physical pain or harm that would outweigh the possibility that resuscitation would successfully restore cardiac or respiratory function for an indefinite period of time.
“Resuscitation" means cardiopulmonary resuscitation or any component of cardiopulmonary resuscitation, including cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of cardiac resuscitation medications and related procedures. “Resuscitation" does not include the Heimlich maneuver or similar procedure used to expel an obstruction from the throat.
Do-not-resuscitate order. 154.19(1)
No person except an attending physician may issue a do-not-resuscitate order. An attending physician may issue a do-not-resuscitate order to a patient only if all of the following apply:
The physician does not know the patient to be pregnant.
The attending physician, or a person directed by the attending physician, shall provide the patient with written information about the resuscitation procedures that the patient has chosen to forego and the methods by which the patient may revoke the do-not-resuscitate order.
After providing the information under par. (a)
, the attending physician, or the person directed by the attending physician, shall document in the patient's medical record the medical condition that qualifies the patient for the do-not-resuscitate order, shall make the order in writing and shall do one of the following, as requested by the qualified patient:
Affix to the wrist of the patient a do-not-resuscitate bracelet that meets the specifications established under s. 154.27 (1)
Provide an order form from a commercial vendor approved by the department under s. 154.27 (2)
to permit the patient to order a do-not-resuscitate bracelet from the commercial vendor.
Except as provided in par. (b)
, emergency medical technicians, first responders and emergency health care facilities personnel shall follow do-not-resuscitate orders. The procedures used in following a do-not-resuscitate order shall be in accordance with any procedures established by the department by rule.
(b) Paragraph (a)
does not apply under any of the following conditions:
The do-not-resuscitate bracelet appears to have been tampered with or removed.
The emergency medical technician, first responder or member of the emergency health care facility knows that the patient is pregnant.
See also ch. DHS 125
, Wis. adm. code.
Wisconsin statutes provide 3 instruments through which an individual may state healthcare wishes in the event of incapacitation: a “declaration to physicians," a “do-not-resuscitate order," and a “health care power of attorney." These statutory instruments apply under specific circumstances, have their own signature requirements, and may be limited in the extent of authorization they afford. A form will trigger no statutory immunities for healthcare providers when it lacks the features of these statutory documents. A court might conclude, however, that such a form is relevant in discerning a person's intent. OAG 10-14
Wisconsin's Do Not Resuscitate Bracelet Law Raises Legal and Medical Issues. Mandel. Wis. Law. Dec. 1997.
Revocation of do-not-resuscitate order. 154.21(1)(1)
Method of revocation.
A patient may revoke a do-not-resuscitate order at any time by any of the following methods:
The patient expresses to an emergency medical technician, first responder or to a person who serves as a member of an emergency health care facility's personnel the desire to be resuscitated. The emergency medical technician, first responder or the member of the emergency health care facility shall promptly remove the do-not-resuscitate bracelet.
The patient defaces, burns, cuts or otherwise destroys the do-not-resuscitate bracelet.
The patient removes the do-not-resuscitate bracelet or another person, at the patient's request, removes the do-not-resuscitate bracelet.
(2) Recording the revocation.
The attending physician shall be notified as soon as practicable of the patient's revocation and shall record in the patient's medical record the time, date and place of the revocation, if known, and the time, date and place, if different, that he or she was notified of the revocation. A revocation under sub. (1)
is effective regardless of when the attending physician has been notified of that revocation.
History: 1995 a. 200
Guardians and health care agents. 154.225(2)
The guardian or health care agent of an incapacitated qualified patient may request a do-not-resuscitate order on behalf of that incapacitated qualified patient and consent to the order and sign it after receiving the information specified in s. 154.19 (2) (a)
. The guardian or health care agent of an incapacitated qualified patient may revoke a do-not-resuscitate order on behalf of the incapacitated qualified patient by any of the following methods:
The guardian or health care agent directs an emergency medical technician, first responder or a person who serves as a member of an emergency health care facility's personnel to resuscitate the patient. The emergency medical technician, first responder or the member of the emergency health care facility shall promptly remove the do-not-resuscitate bracelet.
The guardian or health care agent defaces, burns, cuts or otherwise destroys the do-not-resuscitate bracelet.
The guardian or health care agent removes the do-not-resuscitate bracelet.
History: 1997 a. 27
No physician, emergency medical technician, first responder, health care professional or emergency health care facility may be held criminally or civilly liable, or charged with unprofessional conduct, for any of the following:
Under the directive of a do-not-resuscitate order, withholding or withdrawing, or causing to be withheld or withdrawn, resuscitation from a patient.
Failing to act upon the revocation of a do-not-resuscitate order unless the person or facility had actual knowledge of the revocation.
Failing to comply with a do-not-resuscitate order if the person or facility did not have actual knowledge of the do-not-resuscitate order or if the person or facility in good faith believed that the order had been revoked.
History: 1995 a. 200
General provisions. 154.25(1)
Under this subchapter, the withholding or withdrawing of resuscitation from a patient wearing a valid do-not-resuscitate bracelet does not, for any purpose, constitute suicide. Requesting a do-not-resuscitate order under this subchapter does not, for any purpose, constitute attempted suicide.
(2) Life insurance.
Requesting a do-not-resuscitate order under s. 154.19
may not be used to impair in any manner the procurement of any policy of life insurance, and may not be used to modify the terms of an existing policy of life insurance. No policy of life insurance may be impaired in any manner by the withholding or withdrawal of resuscitation from a qualified patient.
(3) Health insurance.
No person may be required to request a do-not-resuscitate order as a condition prior to being admitted to a health care facility or being insured for, or receiving, health care services.
(4) Other rights.
This subchapter does not impair or supersede any of the following:
A person's right to withhold or withdraw resuscitation.
The right of any person who does not have a do-not-resuscitate order in effect to receive resuscitation.
Failure to request a do-not-resuscitate order creates no presumption that the person consents to the use or withholding of resuscitation in the event that the person suffers from a condition that renders the person a qualified patient.
(6) Valid do-not-resuscitate bracelet.
A do-not-resuscitate bracelet that has not been removed, altered or tampered with in any way shall be presumed valid, unless the patient, the patient's guardian or the patient's health care agent expresses to the emergency medical technician, first responder or emergency health care facility personnel the patient's desire to be resuscitated.
(6m) Desire of the patient.
The desire of a patient to be resuscitated supersedes the effect of that patient's do-not-resuscitate order at all times.
Nothing in this subchapter condones, authorizes or permits any affirmative or deliberate act to end life other than to permit the natural process of dying.
History: 1995 a. 200
; 1997 a. 27
Specifications and distribution of do-not-resuscitate bracelet. 154.27(1)
The department shall establish by rule a uniform standard for the size, color, and design of all do-not-resuscitate bracelets. Except as provided in sub. (2)
, the rules shall require that the do-not-resuscitate bracelets include the inscription “Do Not Resuscitate"; the name, address, date of birth and gender of the patient; and the name, business telephone number and signature of the attending physician issuing the order.
The department may approve a do-not-resuscitate bracelet developed and distributed by a commercial vendor if the bracelet contains an emblem that displays an internationally recognized medical symbol on the front and the words “Wisconsin Do-Not-Resuscitate-EMS" and the qualified patient's first and last name on the back. The department may not approve a do-not-resuscitate bracelet developed and distributed by a commercial vendor if the vendor does not require a doctor's order for the bracelet prior to distributing it to a patient.