DNRs, Falsifying Official Documents, and Compelling Reasons

Image credit: Billie Ward – Creative Commons

I originally posted this on my personal Facebook page but there appears to be a lot of interest so I decided to post it here also.

The Staten Island Advance newspaper reported on May 22, 2015:

Two FDNY paramedics are accused of lying about administering aid to a dying 71-year-old Dongan Hills man — aid they didn’t provide because they sympathized with the patient’s wife, who didn’t want him to be revived but couldn’t find his “do not resuscitate” paperwork, sources familiar with the case said.

I’m not excusing the falsification of patient care records but antiquated protocols and administrative laws that mandate paramedics perform a resuscitation attempt on terminally ill patients because a piece of paper cannot be located are morally and ethically wrong.

It needlessly places us in a difficult situation and distracts us from focusing on palliative care and supporting a grieving family. Our professional associations should take a strong position on this. With or without a DNR, if a resuscitation attempt is futile, inappropriate, or inhumane, we should not be doing it.

This issued is handled very well by our colleagues in King County Medic One in Washington State.

End of Life Toolkit

See “Compelling Reasons” (PDF) on Page 7 of the Resuscitation Academy’s End-Of-Life Toolkit.

Compelling reasons permit EMS personnel to withhold resuscitation from a patient in cardiac arrest when two criteria are BOTH present. These are:

1. End stage of a terminal condition
2. Written or verbal information from family, caregivers or patient stating that patient did not want resuscitation

Here is what the law says in South Carolina:

“SECTION 44-78-40.

Full resuscitative measures required in absence of order.

In the absence of a “do not resuscitate order for emergency medical services”, EMS personnel shall give full resuscitative measures as are medically indicated in all cases.”

The key phrase here is “as are medically indicated”. Get on the phone with Online Medical Control! The wording should be changed. We shouldn’t have to exploit a loophole to do the right thing.

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