Dnr/dni

DNR's are signed by the patient/Power of Attorney and the MD. Patient and/or their legal representatives need to be aware of all ramifications, and may chose to have "modified" codes, also.

Suebird

If the patient is competent then they can make themselves a DNR with the

doctors order. If they are incompetent then the doctor has to sign forms declaring them incompetent and at that point either invokes the Medical Power of Attorney or he appoints a Medical Surogate-usually an agreeable family member who then will make all the decisions for the patient including DNR status with the doctor writing the order for it. A patient can be declared incompetent for specified period of time (i.e. like while on vent and sedated) or it may long term.

In my hospital (in the UK), we dont have patients sign any forms... we just document our evidence. Evidence could be a verbal statement from the patient if they are competent. If they are not competent, any statment of the patients known wishes from when they were competent, from friends and relatives, the family doctor of district nurses or anyone else who knows the patient are acceptabl. The doctor-in-charge would take all of this, and the patients current condition, quality of life and prognosis into consideration when making a final decision. Only the doctor in charge of the patients care can make a final decision.

As far as Power of medical attorney, we only have power of financial attorney, although medical attorney is being discussed at government level

Legally, only a patient can make decisions. Family, friends etc cannot. If the patient isn't competent, the doctor makes the decision and that goes for any medical care

I'm quite surprised that other people can make medical decisions in the States (apart from the doctor)