OUT-OF-HOSPITAL DO-NOT-RESUSCITATE (DNR) MEDICAL DIRECTIVE

(Rhode Island – State Health-Care Law Compliance)

[// GUIDANCE: This template is drafted to satisfy Rhode Island statutory and regulatory requirements for out-of-hospital DNR orders, including EMS recognition and dual-witness execution. Bracketed items must be completed or revised by counsel prior to use. Do not remove the Provider Section—Rhode Island EMS personnel may only honor a DNR if it bears a licensed provider’s signature.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Title. Out-of-Hospital Do-Not-Resuscitate Medical Directive (“Directive”).
2. Parties.
   a. Patient: [FULL LEGAL NAME OF PATIENT], DOB [MM/DD/YYYY], residing at [ADDRESS].
   b. Authorized Health-Care Provider: [NAME, MD / DO / APRN / PA], Rhode Island license No. [NUMBER].
   c. Health-Care Agent (if any): [NAME] under a valid Durable Power of Attorney for Health Care dated [DATE] (“Agent”).
3. Effective Date. This Directive becomes effective on the later of (i) the date executed by the Patient (or Agent) and (ii) the date countersigned by the Authorized Health-Care Provider (the “Effective Date”).
4. Governing Law. This Directive is governed by, and construed in accordance with, the health-care decision laws of the State of Rhode Island, without regard to conflict-of-laws principles.

II. DEFINITIONS

For purposes of this Directive, the following terms have the meanings set forth below:

“Advanced Cardiac Life Support (ACLS)” means any invasive emergency medical procedure—including but not limited to intubation, defibrillation, and administration of cardiac drugs—performed to restart or support cardiopulmonary function.

“Cardiopulmonary Resuscitation (CPR)” means chest compressions, ventilation assistance, and/or ACLS rendered with the intent to restore spontaneous circulation or breathing.

“Emergency Medical Services (EMS) Personnel” means individuals licensed or certified by the Rhode Island Department of Health to provide pre-hospital emergency care.

“Good Faith” means honest belief, absence of malice, and reasonable clinical judgment consistent with accepted medical standards.

“Qualified Witness” means an individual who (i) is at least eighteen (18) years of age, (ii) is not related to the Patient by blood, marriage, or adoption, (iii) is not entitled to any portion of the Patient’s estate, and (iv) is not directly involved in the Patient’s medical care or facility administration.

“Revocation” has the meaning assigned in Section III.5.

III. OPERATIVE PROVISIONS

1. Directive Not to Resuscitate. If the Patient experiences cardiac or respiratory arrest, CPR and ACLS SHALL NOT BE INITIATED, and if already initiated, shall be immediately discontinued.
2. Application to EMS Personnel. EMS Personnel are directed to honor this Directive in any out-of-hospital setting within Rhode Island.
3. Scope of Comfort Care. Nothing in this Directive prohibits the administration of oxygen, pain medication, hemorrhage control, or other comfort-oriented treatments.
4. Authority of Agent. If an Agent is designated, such Agent is authorized to reaffirm, modify, or revoke this Directive in accordance with applicable law and Section III.5.
5. Revocation. This Directive may be revoked at any time by:
   a. A signed and dated writing by the Patient or Agent;
   b. An oral expression of intent to revoke, made in the presence of a health-care provider or EMS Personnel; or
   c. Physical destruction of the original Directive by the Patient.
   Revocation is effective immediately upon communication to medical personnel.
6. Expiration. Unless earlier revoked, this Directive remains effective until [DATE] or, if left blank, indefinitely.
7. Copies. A legible photocopy, facsimile, or electronic copy of this Directive has the same legal effect as the original.

IV. REPRESENTATIONS & WARRANTIES

1. Patient Capacity. The Patient represents that, at the time of execution, they are of sound mind and at least eighteen (18) years of age.
2. Voluntary Execution. The Patient (or Agent) executes this Directive voluntarily, free from duress or undue influence.
3. Provider Certification. The Authorized Health-Care Provider certifies that:
   a. The Patient has been informed of the medical consequences of a DNR order; and
   b. In the Provider’s Good Faith clinical judgment, the DNR order is medically appropriate.
4. Reliance. Third parties may rely on the foregoing representations without further inquiry.

V. COVENANTS & RESTRICTIONS

1. Accessibility. The Patient (or Agent) shall maintain this Directive in an easily accessible location and provide copies to relevant care facilities.
2. Provider Notification. The Authorized Health-Care Provider shall, in Good Faith, enter this order into the Patient’s medical record and notify other treating providers as appropriate.
3. EMS Identification. The Patient is encouraged to wear a Rhode Island-approved DNR bracelet or necklace to facilitate EMS recognition.

VI. DEFAULT & REMEDIES

1. Failure to Honor Directive. If CPR is performed contrary to this Directive, the Patient (or Agent) may seek injunctive relief to enforce this Directive and recover reasonable attorneys’ fees and costs incurred in such enforcement.
2. Good-Faith Exception. No remedy shall lie against EMS Personnel or health-care providers acting in Good Faith reliance on (i) the apparent validity of this Directive or (ii) a communicated revocation.

VII. RISK ALLOCATION

1. Indemnification (Provider Protection). The Patient (and the Patient’s estate) shall indemnify and hold harmless EMS Personnel and health-care providers from any civil liability, claim, or expense (including reasonable attorneys’ fees) arising out of Good-Faith compliance with, or reliance upon, this Directive.
2. Limitation of Liability (Good-Faith Standard). No EMS Personnel or health-care provider shall be liable for damages for withholding or withdrawing resuscitative measures in Good Faith pursuant to this Directive.

VIII. DISPUTE RESOLUTION

1. Governing Law. All disputes arising under this Directive shall be governed by the substantive laws of the State of Rhode Island.
2. Forum. Because this is a health-care directive, forum-selection, arbitration, and jury-waiver provisions are intentionally omitted.
3. Injunctive Relief. Nothing herein limits any party’s right to seek injunctive relief to enforce the terms of this Directive.

IX. GENERAL PROVISIONS

1. Amendment. This Directive may be amended only by executing a new directive that complies with Rhode Island law.
2. Severability. If any provision of this Directive is held invalid, the remaining provisions shall remain in full force and effect.
3. Entire Agreement. This Directive constitutes the entire agreement regarding the Patient’s wishes not to be resuscitated and supersedes all prior DNR directives.
4. Counterparts; Electronic Signatures. This Directive may be executed in multiple counterparts and by electronic signature, each of which shall be deemed an original.

X. EXECUTION BLOCK

[// GUIDANCE: Rhode Island requires ONE licensed provider signature AND TWO qualified witness signatures. Notarization is optional but recommended.]

1. Patient (or Health-Care Agent)

Relationship of Agent to Patient (if applicable): _________

2. Authorized Health-Care Provider

I hereby issue a medical order directing that no resuscitative measures be administered to the above-named Patient in the event of cardiac or respiratory arrest, consistent with Rhode Island law.

3. Witness Attestations

Each witness declares under penalty of perjury that (i) the Patient (or Agent) appeared to execute this Directive voluntarily and with capacity; (ii) the witness meets all requirements of a Qualified Witness; and (iii) the witness is not a health-care provider involved in the Patient’s care.

4. Optional Notary Acknowledgment

State of Rhode Island
County of ________

On [DATE], before me, [NAME OF NOTARY], a Notary Public, personally appeared [NAME(S)], proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to this instrument, and acknowledged that they executed the same in their authorized capacity(ies).

Seal: _____  Signature: ____
My commission expires: __

[// GUIDANCE: Counsel should verify that the completed Directive is (i) filed in the Patient’s medical record, (ii) uploaded to any available state health information exchange, and (iii) provided to the Patient in wallet-card form for EMS visibility.]