DO NOT RESUSCITATE (DNR)

The Office of the State Guardian (OSG) utilizes a form to ascertain that Illinois law is upheld when a guardian or physician is recommending a Do Not Resuscitate (DNR) order for a disabled ward of the court. This document may be viewed at:

http://www.gac.state.il.us/pdfs/DNRForm.pdf

The following are excerpts from this form:


All of the information requested is required to comply with the IL Health Care Surrogate Act (HCSA). 

An attending physician, as well as a second medical opinion ( a concurring physician) must also complete the form.

Questions on the form include the decision making capability of the ward, if a DNR order withholding all resuscitation efforts is recommended; the medical condition in support of consent request; other treatment options; what does the physician feel will cause the patient's death; hospice consideration; and a question regarding ethics which reads: Has an ethics committee reviewed this case?
Qualifying conditions for DNR: Terminal Condition; Permanent Unconsciousness; Incurable or irreversible condition

A second medical opinion is required, and that physician must have examined the ward within the last 24 hours. The physician must sign a statement that he/she concurs that the patient lacks the ability to understand and appreciate the nature and consequences of decisions regarding the foregoing of life-sustaining treatment, and that the ward lacks the ability to reach and communicate an informed decision. I also concur that this request for the withholding and/or withdrawing of treatment is appropriate and warranted due to the nature of this patient's condition. I have also documented these conclusion in the patient's medical chart.