# Are the Deathers (gulp) kinda right? **URL:** \ **Category:** Great Debates\ **Created:** [August 14, 2009, 9:47pm UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452 "2009-08-14T21:47:41Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [August 14, 2009, 11:42pm UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/21 "2009-08-14T23:42:25Z")
> [@intention](#): > > And Kansas … > > Note that in Kansas, the DNR Order must be signed by a) the physician, b) the patient, and c) two witnesses. > > Where is that in the bill? I’m in the middle of a project so I can’t do any research for you, but doesn’t this: > [@](#): > > `(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and Sound like the standardized form that would be used in the give locality? You know, the one with the space for the patient’s name and whatever? ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 14, 2009, 11:52pm UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/22 "2009-08-14T23:52:19Z")
> [@intention](#): > > Here’s Illinois … > > You note the section requiring, I say again requiring, the patient’s signature? Find me that in the bill. Perhaps you missed this clause > [@](#): > > `(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care; Anything the doctor does violating his authority under state law is illegal. ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [August 14, 2009, 11:56pm UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/23 "2009-08-14T23:56:09Z")
As always, the Dope forces me to learn. What I’ve learned is that in some jurisdictions, there is a “DNR Order”, and a “DNR Form”. Kansas calls the latter a “DNR Order Form”. In all the jurisdictions that I’ve found info on, the Doc signs the DNR Order … but he only does so if he is presented with a signed DNR Form. In Kansas, the Doc has to sign both. DSeid, fight my ignorance here … can you legally sign a DNR Order in the absence of a DNR Form? ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [August 14, 2009, 11:57pm UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/24 "2009-08-14T23:57:09Z")
> [@Voyager](#): > > Perhaps you missed this clause > > Anything the doctor does violating his authority under state law is illegal. Voyager, not clear what your point is here. Perhaps you could restate it? Thanks. ---
**Author:** ![Yllaria](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/yllaria/32/3452_2.png) [@Yllaria](https://boards.straightdope.com/u/Yllaria)\ **Post date:** [August 14, 2009, 11:57pm UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/25 "2009-08-14T23:57:37Z")
Are you saying that you want this bill to override the laws that the different states have for DNR orders? You want the feds to take that away from the states? ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 15, 2009, 12:01am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/26 "2009-08-15T00:01:04Z")
Have any of you done estate planning? Medical directives are a part of it. However they are between a person and his or her lawyer. The doctor generally does not have a copy, and in case of an issue the patients relatives must bring the directive to the doctor. We did this very thing when my 89 year old mother-in-law had a hip and shoulder replacement. The purpose of this bill is to say that the insurance will pay for a consultation with the doctor on this, which makes a lot of sense. In this way the doctor knows directly from the patient what is desired, and not have to go by the directive alone. if there is any danger that a doctor could do a DNR without patient consent it exists already without the bill. The clause (which I understand has been removed because of the lies about it) would reduce the chances that a doctor would unwittingly go against the will of the patient. I have no cites for this, but I’d strongly suspect any doctor doing a DNR without consent would be open to a massive malpractice suit and might get his license yanked. Remember first do no harm? A doctor is far more likely to want to keep a patient alive beyond the time it is reasonable than to kill him. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 15, 2009, 12:09am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/27 "2009-08-15T00:09:45Z")
> [@intention](#): > > Voyager, not clear what your point is here. Perhaps you could restate it? Thanks. The clause says the doctor is bound by state law. Thus if the clause had passed, he’d be bound by whatever is required in doing a DNR from the various states. If the require a patient signature (probably notarized) which I’m sure they do, the doctor would be acting unlawfully under both federal and state laws by following one without it. Note that the form also must stay with the individual, so the doctor can’t sign one himself and hide it. But I don’t see anything here overriding state law. We also have > [@](#): > > `(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual. so a directive not executed by the individual, which is your scenario, is not valid. IANAL, but it seems clear that any doctor claiming this clause gives him authority to countermand a patient’s wishes in the way you suggest would be laughed out of court and into the slammer. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 15, 2009, 12:16am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/28 "2009-08-15T00:16:40Z")
My [source](http://www.health.state.ny.us/professionals/patients/patient_rights/molst/frequently_asked_questions.htm) was a quick search which came up with the laws for New York, which allows for verbal consent. And how I was trained back during residency. But, well, it appears that various states now have laws that regulate the DNR process that often, perhaps even most often, require the signatures of the patient or their representative and their doctor both. As a general pediatrician I have not been personally involved in the process for many years so I cannot claim authority. It also appears that there is no federal law right now that requires that, or even requires that there be any standard approach or regulation regarding DNRs and similar orders. If a patient signature _is_ a legal requirement then it is a stupid one, for the reasons I already expressed. Some patients are cognitively capable of making a choice but unable to sign a form. Their preference must be documented and witnessed but a signature requirement fully followed would prevent wishes from being followed in some cases. If it is a lw in some states it is a bad one. So how exactly does a Federal law that requires that all orders regarding life sustaining treatment (including but not limited to DNRs) reflect the patient’s wishes, be standardized within a given state or locality, and be signed by the patient’s doctor change anything from how it already is, even in those states? Are you under the impression that current state laws are somehow made null and void by this? And in any case, what does this have to do with the lie about “death panels”? ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [August 15, 2009, 12:28am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/29 "2009-08-15T00:28:21Z")
Let me see if I can clarify this. The issue I’m pointing to is not whether such an “Order” would be later found illegal in some state, or whether it would be found legal later on for any reason. It is legal when it is signed by any random Physician’s Assistant. The issue to me is that, unlike current practice, it authorizes a doctor or PA or NP to legally issue a DNR order without the signature of the patient. You may not see that as an issue … but it is absolutely not current practice, and it leaves a hole big enough to drive a truck full of conspiracy theories through. I’m not on the truck, I’m not driving the truck, I don’t believe what the people in the truck are saying … I’m just pointing at the hole ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [August 15, 2009, 12:28am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/30 "2009-08-15T00:28:38Z")
Double post…sorry. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [August 15, 2009, 12:30am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/31 "2009-08-15T00:30:10Z")
C’mon… Isn’t this Contract Law 101? To be valid you need the signature of all involved. If a person is incapable of signing for some reason I am betting this is covered too (witnesses or something that attest to the document). ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 15, 2009, 12:38am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/32 "2009-08-15T00:38:19Z")
> [@intention](#): > > Let me see if I can clarify this. The issue I’m pointing to is not whether such an “Order” would be later found illegal in some state, or whether it would be found legal later on for any reason. It is legal when it is signed by any random Physician’s Assistant. Only if the Physician’s Assistant is authorized to sign it under state law. > [@](#): > > The issue to me is that, unlike current practice, it authorizes a doctor or PA or NP to legally issue a DNR order without the signature of the patient. You may not see that as an issue … but it is absolutely not current practice, and it leaves a hole big enough to drive a truck full of conspiracy theories through. I’m not on the truck, I’m not driving the truck, I don’t believe what the people in the truck are saying … I’m just pointing at the hole The order is formulated as part of the consultation. The order must incorporate the patient’s wishes. How does a doctor or whatever issue one willy nilly conform to these clauses? I was not aware of **DSeid** ’s point that some states allow verbal consent. I can see the benefit, though I also see why it might make people nervous. Respecting state law may be the reason why the bill didn’t specifically require a patent’s signature. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 15, 2009, 12:40am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/33 "2009-08-15T00:40:14Z")
> [@intention](#): > > Again, my point is that there is no requirement that the individual signs the order. A doctor could write up anything, and might even sincerely believe it is a statement of the individual’s preferences … but it might also just be a statement of the doctor’s preferences. Without requiring that the individual read and sign the order, anything is possible. So how is this different from what we have now? If a doctor wants to fake a DNR, I don’t think there is anything preventing him. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 15, 2009, 12:42am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/34 "2009-08-15T00:42:53Z")
> [@intention](#): > > The issue to me is that, unlike current practice, it authorizes a doctor or PA or NP to legally issue a DNR order without the signature of the patient. … No, it does not. It just does not _create_ a new Federal law that mandates a patient signature. It does not nullify any state laws that do stupidly require such a signature. And it has nothing to do with the death panel lie. ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [August 15, 2009, 12:45am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/35 "2009-08-15T00:45:40Z")
DSeid, you ask a good question: > [@](#): > > And in any case, what does this have to do with the lie about “death panels”? The order is not limited to a DNR. It can authorize the withholding of any treatment, viz: \The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. \ So under the bill, a Doc can sign an order withholding any given treatment without the patient’s signature or consent … surely you can see how someone might read that as an authorization to withhold lifesaving treatment, not just a DNR order. ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [August 15, 2009, 12:47am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/36 "2009-08-15T00:47:38Z")
> [@Voyager](#): > > Only if the Physician’s Assistant is authorized to sign it under state law. > > The order is formulated as part of the consultation. The order must incorporate the patient’s wishes. How does a doctor or whatever issue one willy nilly conform to these clauses? > > I was not aware of **DSeid** ’s point that some states allow verbal consent. I can see the benefit, though I also see why it might make people nervous. Respecting state law may be the reason why the bill didn’t specifically require a patent’s signature. It says nothing about whether the PA is authorized to sign it under state law. It says it has to be identifiable and standardized. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 15, 2009, 12:48am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/37 "2009-08-15T00:48:25Z")
> [@intention](#): > > So under the bill, a Doc can sign an order withholding any given treatment without the patient’s signature or consent … surely you can see how someone might read that as an authorization to withhold lifesaving treatment, not just a DNR order. I do not believe this is authorized by the part of the bill you cited. ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [August 15, 2009, 1:03am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/38 "2009-08-15T01:03:34Z")
> [@Fear\_Itself](#): > > So how is this different from what we have now? If a doctor wants to fake a DNR, I don’t think there is anything preventing him. The difference is, he doesn’t have to fake it. He is not required by this bill to get the patient’s signature. There is no requirement for witnesses. He doesn’t have to get informed consent. There’s no option for a medical surrogate. Look, folks, I’ve said several times that I think that the intention of the bill is clear, that the Order reflect the patients wishes. But I came across this in the course of trying to figure out why a large section of the populace believes that the docs could do something against their wishes. The answer is, because the Bill can be read that way. The solution should have been simple. Read the bill, understand why people were so agitated, say “Sorry, our intention wasn’t clear, that was never what we were trying to say. Here’s the new language to make sure that what you are afraid of can’t happen.” Instead, we Democrats were so busy demonizing the opposition that we didn’t notice what they were upset about. And now, it’s been removed from the bill. This is a loss to the bill, but that’s not the only loss. Since it was removed by Republicans, the Demos can still be demonized as heartless monsters … bad tactics on our part. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 15, 2009, 1:06am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/39 "2009-08-15T01:06:51Z")
> [@intention](#): > > The difference is, he doesn’t have to fake it. Are you under the impression he would have to fake it now? Do you know how a DNR works? ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [August 15, 2009, 1:35am UTC](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452/40 "2009-08-15T01:35:38Z")
> [@intention](#): > > Look, I know they’re crackpots. I’m just saying the bill’s language is dangerously vague. The intention is that doctors will get paid for consulting about end of life conferences. It includes treatment, hospice and living will discussion. [Previous page](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452.md?page=1) [Next page](https://boards.straightdope.com/t/are-the-deathers-gulp-kinda-right/506452.md?page=3)