Attorney General Advice Letters

Attorney General advice letters cited in the Manual are available below as PDFs:

• Letter to Harold B. Bob, M.D. - May 28, 2008 re: Effect of treatment refusal in Life-Sustaining Treatment Options Form. This letter explains why a competent patient's instruction against the use of CPR and a ventilator does not foreclose a health care agent or surrogate from later consenting to suspension of a DNR/DNI order during palliative surgery.
• Letter to Jean Seifarth - April 25, 2000 re: Informed consent and oral advance directives. The letter explains when a patient's statement about end-of-life care falls within the informed consent doctrine and when it should be reflected in an advance directive.
• Letter to Frances C. Stoner - July 28, 2000 re: Nursing home resident's refusal of CPR. This letter explains why a nursing home should not perform CPR on a resident who has refused it, even if a physician's DNR order is not yet on the chart.
• Letter to Howard L. Sollins - June 10, 2008 re: Domestic partner as surrogate. This letter explains that facilities have discretion about confirming and documenting a domestic partner's status as a surrogate.
• Letter to Howard L. Sollins - May 9, 2007 re: "Specially empowered" guardian. This letter explains why a guardian who has been empowered by court order to decide about the use of life-sustaining medical treatments without need for additional, specific court approval nevertheless remains subject to the decision-making criteria and limitations applicable to surrogates.
• Letter to Anita J. Tarzian, Ph.D., R.N. - January 17, 2003 re: Medically ineffective treatment and guardianship. This letter explains that, once a guardian takes a reasonable step to notify the court of a certification that attempted CPR would be medically ineffective, the guardian need take no other action unless requested to do so by the court.
• Letter to Howard L. Sollins - February 20, 2007 re: Living wills, health care agents, and status pending transfer: The letter discusses the situation presented when a patient's living will expresses a clear wish to forgo tube feeding, yet the health care agent insists that it be provided indefinitely pending transfer of the patient.
• Letter to Herbert H. Hubbard - October 25, 2005 re: Patient's Plan of Care form. This letter confirms that a decision on the form for use of a life-sustaining treatment is subject to the Act's provisions on medically ineffective treatment.
• Letter to Harold B. Bob, MD - November 8, 2005 re: Patient's Plan of Care form and surrogate authority. The letter analyzes how the Act's requirement on certification of condition affects a surrogate's completion of the form and the entry of physician orders to implement surrogate decisions about feeding tube use.
• Letter to Vanessa R. Bishop, LCSW-C - April 23, 2003 re: Scope of EMS/DNR Orders. The letter explains that an EMS/DNR order only addresses the use of interventions related to cardiopulmonary arrest, not other therapeutic interventions.