Do Not Resuscitate Declaration Mexico (Declaración Voluntaria de No Reanimación)

A Do Not Resuscitate Declaration (Declaración Voluntaria de No Reanimación) in Mexico is a formal legal and medical document by which a terminally ill patient (enfermo en situación terminal) expressly and voluntarily instructs healthcare providers not to administer cardiopulmonary resuscitation (reanimación cardiopulmonar — RCP) in the event of cardiac or respiratory arrest. The legal framework governing this declaration is the Ley General de Salud (LGS), specifically the Capítulo IV-Bis titled Voluntad Anticipada, introduced by the Decreto published in the Diario Oficial de la Federación on 5 January 2009, and principally Article 166-Bis 3, which establishes the patient's right to refuse extraordinary resuscitation measures.

Article 166-Bis 3 of the Ley General de Salud recognizes the right of terminally ill patients to refuse artificial prolongation of life through extraordinary means, including cardiopulmonary resuscitation, mechanical ventilation, and other life-support technologies when their primary purpose would be to prolong the dying process without reasonable expectation of recovery. This right forms part of the broader constitutional and statutory right to a dignified death (derecho a la muerte digna) — a concept rooted in the fundamental rights of personal dignity and physical autonomy under Article 1 of the Constitución Política de los Estados Unidos Mexicanos and developed through the Ley General de Salud's voluntary anticipation framework.

The Ley General de Salud also establishes the broader Documento de Voluntad Anticipada (DVA) framework under Articles 166-Bis through 166-Bis 21, which allows competent adults to document their healthcare wishes in advance. The DNR declaration under Article 166-Bis 3 operates as a specific component within this framework, addressing the particular situation of resuscitation refusal. The NOM-011-SSA3-2014 (Norma Oficial Mexicana for terminal illness care and palliative care) issued by the Secretaría de Salud establishes the clinical and administrative criteria for implementing DNR orders in healthcare institutions.

At the federal level, the LGS governs healthcare institutions under federal jurisdiction, including IMSS hospitals under the Ley del Seguro Social, ISSSTE (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado) under its ley orgánica, and all Secretaría de Salud facilities. However, several Mexican states — including Distrito Federal (now Ciudad de México), Coahuila, San Luis Potosí, Hidalgo, Guanajuato, Aguascalientes, Michoacán, Oaxaca, and others — have enacted their own Ley de Voluntad Anticipada at the state level, providing complementary procedures for DVA and DNR declarations that may have specific formality requirements (notarization, witness requirements, registration) additional to the federal LGS framework.

The declaration must specify clearly that the patient is a terminally ill person (enfermo en situación terminal) as defined in Article 166-Bis 1 of the LGS — a person whose illness has been clinically confirmed by a treating physician as incurable, irreversible, and expected to cause death within a period generally not exceeding six months. The treating physician's written confirmation of terminal status is a standard component of a valid DNR declaration in Mexican healthcare settings.

The Secretaria de Salud of Mexico City (CDMX) maintains a Registro de Voluntades Anticipadas under the Ley de Voluntad Anticipada para el Distrito Federal published in the Gaceta Oficial on 7 January 2008, the first state-level law in Mexico to formally regulate advance healthcare directives. Patients who execute a DNR declaration in CDMX may register it in this Registro, making it accessible to any healthcare institution in the capital regardless of where the patient is admitted. Other states with enacted Leyes de Voluntad Anticipada maintain equivalent registries. Federal IMSS and ISSSTE facilities recognise DNR declarations executed under both the federal LGS framework and applicable state legislation, provided the clinical and formal requirements of NOM-011-SSA3-2014 are satisfied at the time of execution.

A Do Not Resuscitate Declaration in Mexico under Ley General de Salud art. 166-Bis 3 is needed in specific medical and legal situations involving terminally ill patients who wish to formally document their refusal of resuscitation measures. The declaration becomes legally and medically relevant when a patient with terminal illness is admitted to or treated at a hospital, clinic, hospice (unidad de cuidados paliativos), or other healthcare institution subject to the LGS.

The DNR declaration is needed when a competent terminally ill adult — one who retains decision-making capacity (capacidad de decisión) under Article 166-Bis 7 of the LGS — wishes to formally instruct attending physicians, nursing staff, and emergency responders not to initiate RCP in the event of cardiopulmonary arrest. The formal declaration ensures that the patient's wish is documented in their clinical record (expediente clínico) maintained under NOM-004-SSA3-2012 and NOM-011-SSA3-2014, and that healthcare personnel are legally protected when they honor the DNR order.

The declaration is also needed when a patient has lost decision-making capacity and their legal representative (representante legal) — typically the person holding a Poder Notarial para Actos de Salud or the patient's previously designated healthcare proxy — must exercise the patient's right to refuse resuscitation on their behalf under Article 166-Bis 8 of the LGS. In such cases, the legal representative must present evidence of their authority (poder notarial or legal representative designation) alongside the DNR declaration.

A DNR declaration is specifically needed when a patient is being transferred between healthcare facilities — the declaration must travel with the patient's medical record and must be recognized by the receiving institution. Under the NOM-011-SSA3-2014, all healthcare institutions are required to maintain DNR orders prominently in the patient's expediente clínico and to ensure that all treating personnel are aware of its existence.

The declaration is also needed in home care and hospice settings: patients receiving palliative care at home through public or private providers must have a formal DNR declaration to ensure that emergency services (Servicio de Urgencias Médicas — SUEM) and paramedics do not initiate resuscitation contrary to the patient's wishes when responding to a call.

A valid Do Not Resuscitate Declaration in Mexico under Ley General de Salud art. 166-Bis 3 and NOM-011-SSA3-2014 must contain the following essential elements to be recognized and honored by healthcare institutions and medical personnel.

Patient Identification: Full legal name of the patient (nombre completo del paciente), CURP (Clave Única de Registro de Población), date of birth, sex, and residential address. The patient's identification must match the clinical record (expediente clínico) maintained by the treating healthcare institution under NOM-004-SSA3-2012. Medical record number (número de expediente clínico) should be included where available.

Confirmation of Terminal Illness: A statement confirming the patient's status as an enfermo en situación terminal under Article 166-Bis 1 of the LGS, including the primary diagnosis, the treating physician's name and Cédula Profesional (professional license number issued by the Dirección General de Profesiones of the SEP), and the physician's clinical confirmation that the illness is incurable, irreversible, and terminal. The Cédula Profesional is required to verify the physician's legal authority to practice medicine under the Ley General de Profesiones and LGS art. 79.

Voluntary and Competent Declaration: An express statement by the patient (or legal representative) that the DNR instruction is made voluntarily (voluntaria y libremente), without coercion, and with full understanding of its medical implications. If the patient has decision-making capacity, the declaration must reflect their own autonomous choice under LGS art. 166-Bis 7. If made by a legal representative on behalf of an incapacitated patient, the basis for the representative's authority must be stated and documented.

Specific DNR Instructions: Clear and unambiguous instructions specifying which resuscitation measures are refused, which may include: cardiopulmonary resuscitation (RCP), mechanical ventilation (ventilación mecánica), defibrillation (desfibrilación), vasopressor medications, artificial nutrition and hydration, and other extraordinary life-sustaining measures. The LGS and NOM-011-SSA3-2014 distinguish between extraordinary life-sustaining measures (which may be refused) and basic palliative care measures such as pain relief, sedation for comfort, and oral hydration (which remain obligatory under LGS art. 166-Bis 19).

Healthcare Institution Acknowledgment: Identification of the healthcare institution where the declaration is being made and registered, including the name of the attending physician, their Cédula Profesional, the institution's name, and the treating service (servicio médico) where the patient is receiving care. The institution must incorporate the declaration into the patient's official expediente clínico.

Witnesses: Under many state Ley de Voluntad Anticipada laws (including the Ley de Voluntad Anticipada para el Distrito Federal), two adult witnesses are required to sign the DNR declaration, confirming that the patient made the declaration voluntarily and without pressure. Federal LGS art. 166-Bis 9 also recommends witness signatures. Witnesses must not be beneficiaries of the patient's estate, healthcare providers directly involved in the patient's care, or representatives of the healthcare institution.

Forms-legal.com provides this Do Not Resuscitate Declaration template as a preparatory document for Mexico. Patients and families should engage a Licenciado en Derecho specializing in derecho de salud or a Notario Público familiar with state Ley de Voluntad Anticipada requirements to ensure the declaration meets all applicable state and federal formality requirements. In states with enacted Ley de Voluntad Anticipada, formal registration of the declaration may be required. Related documents include the Poder Notarial para Actos de Dominio (mx-poder-notarial-actos-dominio) and the Declaratoria de Herederos Notarial (mx-declaratoria-herederos-notarial) for comprehensive estate and healthcare planning.

Related healthcare planning documents include the Poder Notarial para Actos de Salud (mx-poder-notarial-salud) for designating a healthcare proxy with full legal authority under the Codigo Civil Federal and applicable state law, the Directiva Anticipada de Salud (mx-directiva-anticipada-salud) for a comprehensive advance directive covering all healthcare decisions beyond resuscitation, and the Testamento Vital (mx-testamento-vital) for patients wishing to document end-of-life wishes in a notarially certified instrument. Together these documents form a complete advance healthcare planning package under Mexican federal and state law.