Prepared by: Jack Freer MD
Law by Treatment Decision
The way in which each kind of treatment decision is regulated by the various laws in NYS|
Case Law |
DNR Law |
HCProxy Law |
|
|
CPR |
Competent patients may refuse any treatment including CPR |
DNR Law applies specifically to CPR (and only CPR) decisions |
A health care agent may make all * decisions (including CPR) for incapacitated patient |
|
Non-CPR Intubation- Ventilator |
Competent patients may refuse any treatment including ventilator |
DNR Law does NOT apply to intubation-ventilation outside of an arrest |
A health care agent may make all * decisions (including ventilator) for incapacitated patient |
|
Other *Treatment |
Competent patients may refuse any treatment |
DNR Law does NOT apply |
A health care agent may make all * decisions for incapacitated patient |
|
* Hydration-Nutrition |
Competent patients may refuse any treatment (including hydration-nutrition) |
DNR Law does NOT apply |
* A health care agent may make all decisions for incapacitated patient (but must be familiar with patient wishes re: H-N) |
*
See belowLaw by Type of Advance Directive
How each kind of advance directive is supported by the various laws in NYS|
Case Law |
DNR Law |
HCProxy Law |
|
|
Instructional: Prior Verbal Statement |
Prior treatment decisions are respected if they are specific and serious |
Prior DNR decisions are respected |
N/A |
|
Instructional: Prior Written Statement (Living Will) |
Prior treatment decisions are respected if they are specific (presumed to be serious because they are written) |
Prior DNR decisions are respected |
Instructions are sometimes included on a combination health care proxy and living will form |
|
Proxy: Health Care Proxy |
N/A |
Top name on surrogate list (if incapacitated) is HCP agent |
HCP is the proxy directive approved in NYS |
|
Proxy: Durable POA for Health Care |
N/A |
DPOAHC is acceptable in NYS if it was executed in a state that uses that form of proxy designation |
DPOAHC is acceptable in NYS if it was executed in a state that uses that form of proxy designation |
Law by Decision Maker
Who is actually authorized to make the decisions under each law (if the patient is authorized, he or she must have made the decision in advance of becoming incapacitated)|
Case Law |
DNR Law |
HCProxy Law |
|
|
Patient |
YES |
EITHER |
NO |
|
Surrogate |
NO |
YES |
*
The Health Care Proxy Law authorizes the agent to make any medical decision for an incapacitated patient, except hydration-nutrition decisions (unless the agent is familiar with the patients wishes in that regard). Note: this does not have to be at the same level of specificity as for instructional ADs in NYS. In other words, the patient did not have to spell out all the circumstances under which it would be permissible to forgo H/N, but only that it would be OK for the agent to decide to do it. Some people believe H/N are always obligatory and must never be withheld. The clause here is to make sure the patient did not feel that way, and that the agent was empowered to make such decisions.