Has any one had a 'do not resuscitate order' (DNR) prepared based on Jalisco state law?

Under Jalisco State Law, a do not resuscitate order (DNR) is available, but for specific purposes.
Supposedly the document does not include a power of attorney, only the directive. And, the directive does not expire like Jalisco State Poders which expire in 5 years. Apparently a notario does not have to sign it, but it is recommended that a notario sign it.

Has anyone had one of these documents prepared? I'm interest in knowing if it is only the DNR that is stated as a directive and what the language is, and who prepared it.

Thanks,

I would like to hear what Spencer has to add too. Great Topic!

For my primary contact, I used Lic Ana Cecelia Villanueva, attorney with Acosta & Associates in Guad and she's legal counsel for Puerta de Hierro Hospital. And, she knows Spencer. Spencer may have some to add to this, but Ana will have more applied experience because of her relationship to the hospital. In any event, Spencer's input would be appreciated.

I have the legal Article from her and will get around to posting it. Initially, I just wanted to see if anyone has input at a practical level.

Ana has also indicated that we can put a DNR in our NOB durable powers of attorney for health, get them apostilled and translated here for use here, which means that we would not have to get a separate document valid for the State of Jalisco.

On the advice of our lawyer, Notario #2, we had the "heroic efforts" phrasing added to our powers of attorney. He assured us that would provide sufficient direction to medical care providers.
 
SunFan

Is "heroic efforts" defined? If not, it seems a little vague, especially in Mexico.

Try pinning a note & 200 pesos to the patient's jacket.

I am not really up on all these issues, although will chat with my fiancee who used to work as legal counsel for the hospital.

SunFan wrote:On the advice of our lawyer, Notario #2, we had the "heroic efforts" phrasing added to our powers of attorney. He assured us that would provide sufficient direction to medical care providers.
 
SunFan

That same notario was writing and charging for health care directives long before there was ever any legislation passed (I know people who had those directives) in 2009/Mexican Federal Palliative Health Care Directive and 2011/Jalisco State legislation for a Curative Care health care directive......

In an interview with Dr. Garcia, he commented to me that lots of health care directives were written lakeside and they would be followed here because the health care providers were used to working with the foreigner. But, he said then, that in the end, the law was on his side and he would make the final decisions. The problem with the health care directives was that when people got into a hospital in Guad, especially a private hospital, the health care directives were not legally binding or valid and only showed intent of the patient. In the end, the hospital administrators or doctor in charge made the decision.

So, do you know there's legislative backup and have you seen the legal Article in writing....., or asked another legal professional, or the hospital where you might be in Guad or any of the your health care providers as to what is really 'good enough' or not?

Intercasa wrote:I am not really up on all these issues, although will chat with my fiancee who used to work as legal counsel for the hospital.  

Thanks Spencer for checking with Ana.  Below are the two articles to which she referred for the DNR.

I want to get a good understanding of what is legally available, how that is applied and what sort of document needs to be prepared to support a DNR under Jalisco State Law.  Ana also mentioned that the DNR can come in a NOB health care directive that has been apostilled and translated into Spanish by a certified translator.  For many of us, that is an option.


Artículo 93.‑ Los usuarios tienen derecho a:

I. Obtener servicios de salud con oportunidad y a recibir atención profesional y éticamente responsable;

II. Recibir información suficiente, clara, oportuna y veraz, así como la orientación que sea necesaria respecto a la atención de su salud y sobre los riesgos y alternativas de los procedimientos diagnósticos, terapéuticos y quirúrgicos que se le indiquen o apliquen; y

III. Otorgar o no su consentimiento válidamente informado y a rechazar tratamientos o procedimientos.


Artículo 124.‑ En cualquier tratamiento de una persona enferma, el médico podrá utilizar nuevos recursos terapéuticos o de diagnóstico, cuando exista posibilidad fundada de salvar la vida, restablecer la salud o disminuir el sufrimiento del paciente, siempre que cuente con el consentimiento por escrito de éste, de su representante legal o, en su caso, del familiar más cercano en vínculo y sin perjuicio de cumplir con los demás requisitos que determine esta Ley y otras disposiciones legales aplicables.

Right to refuse treatment under federal law

LEY GENERAL DE SALUD

Artículo 77 bis 37.- Los beneficiarios del Sistema de Protección Social en Salud tendrán además de los derechos establecidos en el artículo anterior, los siguientes:

IX. Otorgar o no su consentimiento válidamente informado y a rechazar tratamientos o procedimientos;

HEALTH LAW
This is the google translation for Article 77 bis 37.
Article 77 bis 37. - The beneficiaries of the Social Protection System in Health will be in addition to the rights set forth in the preceding article, the following:

IX. Granting or not validly informed consent and refuse treatment or procedures;

Also google translate (which means I don't know how accurate the translation is ..... but the general idea should be there).

Article 93. - Users are entitled to:

I. Get health services in a timely and professional care and ethically responsible;

II. Receive sufficient, clear, timely and accurate information and necessary guidance regarding your health care and the risks and alternatives to the diagnostic, therapeutic and surgical procedures that are indicated or applied, and

III. Granting or not validly informed consent and refuse treatment or procedures.


Article 124. - In any treatment of a sick person, the doctor may use new therapeutic or diagnostic resources, when potential founded in saving life, reestablishing health or reduce the suffering of the patient, provided they have written consent of this, its legal representative or, where applicable, the next of kin in bond and subject to meeting the other requirements determined by this Law and other applicable laws.

Lic Villanueva stated that the 'informed consent', where the individual may determine what procedures they are willing to receive or not receive from medical institutions, is not as broad as the (MX) federal law, but it can still be stated in such 'informed consent' that the individual does not want to receive extraordinary treatment to preserve life or to be resuscitated, but only to mitigate the pain until the natural death happens.  

She went on to say that the DNR is NOT a power of attorney as it is known in the Civil Code.  It is a consent established in the health law, which does not expire (my note: in the State of Jalisco, all powers of attorney (PODERS) expire in 5 years and there can be the issue of durability  (Artículo 2214.- Ningún poder se otorgará por una duración mayor a cinco años, salvo que antes de que se cumpla ese
tiempo, el mandante lo revoque.
Cuando durante la vigencia del poder, se hubiere iniciado un negocio cuya duración trascienda el término de su vigencia,
se entenderán prorrogadas las facultades, hasta su conclusión, quedando comprendida la de intentar el juicio de Amparo.)

The federal and state articles noted in this thread therefore not only provide for a DNR, but for a directive that remains in place until it is revoked or replaced by a new document; which means it does not expire like a Jalisco State Poder.

My questions and comments:

Should the DNR be written as a stand-alone Jalisco State document (and not written inside a State Poder since the State Poder expires)?
If it is written as a stand-alone document, Lic Villanueva suggested it be signed by a Jalisco State Notario.

Or, should the DNR statement be written within the context of the MX federal end-of-life legislation, which is for people who have been diagnosed  with a terminal situation and expected to live 6 months or less.  This federal document does not require the signature of a State of Jalisco Notario, only requires the signature of the maker, and 2 witnesses.  It does not expire and remains in place until it is revoked by the maker or a new document written.  It does not have to be prepared by an attorney or a notario.  (Decree reforming and adding to the General Health Law of Palliative Care Matters - DOF from 05 of January 2009).

And/or, for those of us with a foot NOB and access to durable powers of attorney for health (or health care directive) from outside of MX, do we just include a DNR in our health care directives, which have been apostilled and legally translated into Spanish?  These documents remain valid until they are revoked or new ones written (they do not expire like the Jalisco State Poder, they are Durable (of you don't know what this means, look it up) and they are directives that go beyond a terminal diagnosis (this is an important distinction in dealing with people with dementia or Alzheimers).

Or, can we do one or all 3 options with each having an equal standing here in the State of Jalisco?

P.S.  I was not aware that Lic Villanueva was no longer counsel for Puerta de Hierro.  I assume she is still at Acosta & Associates?  She's been a great resource for me in working on the publication Life Planning in Jalisco for the last few years.  She consistently supports the information she provides with the State or Federal articles as appropriate and is very professional.

She is attorney for the administrator of a large commercial complex in Guadalajara doing more corporate law although she still finds time to help review my work.

Intercasa wrote:She is attorney for the administrator of a large commercial complex in Guadalajara doing more corporate law although she still finds time to help review my work.  

Intercasa is a lucky guy!!

Getting a DNR from NOB ..... that can be used here .... recognized and legally valid!  Yes, it's possible.

This is actually is fairly easy.

If you are from the US, a long-time legal reference for help is Nolo Press, which has lots of publications, lots of self-education material, attorneys to contact, etc.

The website is www.nolo.com

If you are Canadian, you can accomplish the same thing, but you have to go through your consulate and will have to ask about the process.  Canada was not a signer to the Hague Agreement which is why the process is different.

If you want a DNR, or the equivalent, just go to Nolo Press, query DNR and find the information for your specific State.  The information will likely be located with estate planning, living wills, durable powers of attorney and more.

Each state is slightly different, so you need to find the state to which you are or were last connected.

The documents can be written from that State, by an attorney or yourself, signed by a notary public (not a MX notario), the document needs to be apostilled and legally translated here by a Supreme Court certified translator.  The documents are then good to go.  

You may want to inform your local doctor(s) that you have a DNR, health care directives, and/or a durable power of attorney for medical decisions from NOB.  The major hospitals in Guadalajara are familiar with these documents.

The international agreement that allows this to happen is the "Hague Agreement".  The full citation is on my website www.lifeplanninginjalisco.wordpress.com Look under references and resources.  If you want some dry, but informative reading, the Hague Agreement is in English on their website.

Hopefully Spencer will come up with the form/format for the DNR needed here.   As mentioned, Lic Villanueva suggested it be signed by a notario here.  I don't make recommendations for notarios lakeside .... but the only one I know of who has some real familiarity with NOB documents is Sergio Macias (the son, not the father) who is now a notario for Tuxcueca, but you can still make an appointment with him at the Chapala Office for Notario 5 (more/less across the street from Spencer's office).