On July 20, revised regulations on Durable Do Not Resuscitate Orders (DDNR) go into effect. The revised regulations will help clarify the effect of DDNR forms in Virginia. Significantly, the regulations make a fundamental change to the law by enabling copies of DDNRs to be honored.

The Forms

The revised regulations clarify the effect and breadth of the three Virginia recognized DDNR forms. First, the official state-issued DDNR form is a standardized document approved by the Virginia Department of Health. This form, which had previously only been available in hard copy from the Virginia Department of Health, will now be made available online. Although forms are not yet available online, presumably they will be available for patients to download and bring to their physicians. Second, DDNR jewelry are uniquely identifiable necklaces and bracelets that can only be issued by a vendor approved by the Virginia Department of Health. Third, “Other DNR Orders” are physician-issued orders, other than the state-authorized DDNR form, that are issued pursuant to the policies and procedures of the healthcare facility to which a patient has been admitted. While the official DDNR form and DDNR jewelry may be honored anywhere, Other DNR Orders are only effective when the patient is currently admitted to the healthcare facility where such form is issued, or is being transferred to another facility. Because of this limitation, the revised regulations expressly encourage the use of the authorized DDNR form.

Copies

The most important change to the regulations is that a legible copy of a DDNR form or Other DNR Order will now be honored as an original. Prior to this change, patients needed to keep an original form with them at all times in order to ensure their wishes were honored.

Physician Notice

The revised regulations also specifically require physicians to explain certain aspects of DDNRs prior to issuing one. A physician must now explain the circumstances under which healthcare personnel may follow a DDNR form, and how and who may revoke the DDNR.

Revocation

Consistent with Virginia’s Health Care Decisions Act, the revised regulations specifically state that only the patient has the authority to revoke a DDNR or Other DNR Order that the patient authorized. A third-party authorized decision-maker can revoke the DDNR or Other DNR Order of a minor or someone who is otherwise incapable of making an informed decision only when the authorized decision-maker initially authorized the order. This provision is meant to aid providers in honoring orders authorized by patients when family or friends request that the order be rescinded.