“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.
History: 1995 a. 200
; 1999 a. 9
See also ch. DHS 125
, Wis. adm. code.
Any person who willfully conceals, defaces or damages the do-not-resuscitate bracelet of another person without that person's consent may be fined not more than $500 or imprisoned for not more than 30 days or both.
Any person who, with the intent to cause the withholding or withdrawal of resuscitation contrary to the wishes of any patient, falsifies, forges or transfers a do-not-resuscitate bracelet to that patient or conceals the revocation under s. 154.21
of a do-not-resuscitate order or any responsible person who withholds personal knowledge of a revocation under s. 154.21
is guilty of a Class F felony.
Any person who directly or indirectly coerces, threatens or intimidates an individual so as to cause the individual to sign or issue a do-not-resuscitate order shall be fined not more than $500 or imprisoned for not more than 30 days or both.
AUTHORIZATION FOR FINAL DISPOSITION
Control of final disposition of certain human remains. 154.30(1)(a)(a)
“Authorization for final disposition" means a document that satisfies the conditions under sub. (8) (d)
, and that is voluntarily executed by a declarant under sub. (8)
, but is not limited in form or substance to that provided in sub. (8)
“Declarant" means an individual who executes an authorization for final disposition.
“Estranged" means being physically and emotionally alienated for a period of time, at the time of the decedent's death, and clearly demonstrating an absence of due affection, trust, and regard.
“Final disposition" means disposition of a decedent's remains, including any of the following:
A funeral ceremony, memorial service, graveside service, or other last rite.
A burial, cremation and burial, or other disposition, or donation of the decedent's body.
“Health care provider" means any individual who has a credential to provide health care.
“Representative" means an individual specifically designated in an authorization for final disposition or, if that individual is unable or unwilling to carry out the declarant's decisions and preferences, a successor representative designated in the authorization for final disposition to do so.
(2) Individuals with control of final disposition; order. 154.30(2)(a)(a)
Notwithstanding s. 445.14
and except as provided in par. (b)
and sub. (3)
, any of the following, as prioritized in the following order, who is at least 18 years old and has not been adjudicated incompetent under ch. 54
or ch. 880
, 2003 stats., may control final disposition, including the location, manner, and conditions of final disposition: