Hostname: page-component-84b7d79bbc-7nlkj Total loading time: 0 Render date: 2024-07-30T20:47:07.891Z Has data issue: false hasContentIssue false
  • English
  • Français

Current Controversies in Prehospital Resuscitation of the Terminally Ill Patient

Published online by Cambridge University Press:  28 June 2012

R. Jack Ayres Jr
R. Jack Ayres Jr
Affiliation:
The author heads a private, civil practice in Dallas, Texas. He also is a faculty member at theUniversity of Texas Health Science Center—Southwestern Medical School, the Director of the Emergency Legal Assistance Program at Parkland Hospital, and a national lecturer in legal issues involving emergency and prehospital care.
Get access Rights & Permissions [Opens in a new window]

Extract

Prehospital health-care providers regularly are called upon to assist terminally ill patients in residential or institutional, non-hospital settings such as nursing homes or hospices. Among the most crucial issues regarding such patients is whether they should be resuscitated. With alarming frequency, EMS providers are encountering vigorous and sometimes violent refusals of examination, treatment, and/or transportation from the terminally ill patient, members of the patient's family, or third persons ostensibly acting on the patient's behalf. Today, the prehospital emergency health-care provider repeatedly is faced with the legal and ethical questions that surround the issue of resuscitation and advanced life support.

Type
Collective Review
Information
Prehospital and Disaster Medicine , Volume 5 , Issue 1 , March 1990 , pp. 49 - 57
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. American College of Emergency Physicians (ACEP): Guidelines for “Do Not Resuscitate” orders in the prehospital setting. Ann Emerg Med 1988; 17:1106–1108.CrossRefGoogle Scholar
2. ACEP: Guidelines, Ann Emerg Med 1988; 17:1106–1108. The ACEP board has also adopted six policy statements on the ethics of resuscitation. The third policy statement is of specific relevance to prehospital resuscitation: “A decision to forego resuscitation in the field is appropriate only with the approval of physician-directed medical control, in keeping with written protocols developed with the concurrence of community agencies and in keeping with community standards.”Google Scholar
3. The National Association of EMS Physicians has recently published a discussion draft entitled “NAEMSP Consensus Document on Resuscitation Decisions in the Prehospital Setting” in the NAEMS Official Newsletter. Pittsburgh, Pa: NAEMSP, 1989 (special edition). See also Life and Death Choices, Symposium Edition. Law, Medicine & Health Care, 1989; 17:208–268Google Scholar
4. American Heart Association (AHA): Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. JAMA 1986; 255, 21:2841.Google Scholar
5. American Heart Association (AHA): Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. JAMA 1986; 255, 21: 2841–3044.Google Scholar
6. American Heart Association (AHA): Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. JAMA 1986; 255, 21: 2980.Google Scholar
7. American Heart Association (AHA): Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. JAMA 1986; 255, 21: 2980, note 4.Google Scholar
8. Haynes, BE, Niemann, JT: Letting Go: DNR Orders in Hospital Care. JAMA 1985; 254:532–533.CrossRefGoogle Scholar
9. AHA: Standards and Guidelines. 2981Google Scholar
10. Haynes, Niemann: DNR Orders. 532–533.Google Scholar
11. AHA: Standards and Guidelines. 2979–2981.Google Scholar
12. ACEP: Guidelines. 1106–1108.Google Scholar
13. AHA: Standards and Guidelines. 2981–2982.Google Scholar
14. Aranosian RO: Medical-Legal Concerns in EMS, in Principles of EMS Systems. Pub locale: American College of Emergency Physicians, 1989:165–174.Google Scholar
15. Rabkin, MT, Gillerman, G, Rice, NR: Orders not to resuscitate. N Engl J Med 1976; 295:364–366. See alsoCrossRefGoogle ScholarPubMed
Miles, SH, Cranford, R, Schultz, AL: The Do Not Resuscitate Order in a Teaching Hospital. Ann Intern Med 1982; 96:660–664.CrossRefGoogle Scholar
16. Garza, M: To Resuscitate or Not to Resuscitate. JEMS 1989; 1314. This selection provides an example of prehospital providers' “common misunderstanding” of DNR orders.Google ScholarPubMed
17. Joint Commission on Accreditation of Health Care Organizations (JCAH), Accreditation Manual for Hospitals. 1988; Sec MA 1.4.11:90.Google Scholar
18. AHA: Standards and Guidelines. 2981.Google Scholar
19. AHA: Standards and Guidelines. 2981.Google Scholar
20. Rabkin, , et al: Orders Not to Resuscitate. 364–366.CrossRefGoogle Scholar
21. Rizzo, RF: The Living Will: Does It Protect the Rights of the Terminally Ill? NY State J Med 1989; Feb:72–79.Google ScholarPubMed
22. Rabkin, , et al: Orders not to resuscitate. 364–366.CrossRefGoogle Scholar
23. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: Report on: Deciding to Forego Life-Sustaining Treatment. Washington DC: Government Printing Office, 1983; 25.Google Scholar
24. Rizzo, . The Living Will. 74.Google Scholar
25. Miles, SH, Crimmins, TJ: Orders to limit emergency treatment for an ambulance service in a large metropolitan area. JAMA 1985; 284:525–527.CrossRefGoogle Scholar
26. Haynes, Neimann. DNR Orders 532–533.Google Scholar
27. See for example, Tex Civ Stat §, Art. 4590(h): The Texas Natural Death Act. Vernon's Texas Civil Statutes Annotated.Google Scholar
28. Taffett, GE, Teasdale, TA, Luchi, RJ: Inhospital cardiopulmonary resuscitation. JAMA 1988; 260:2069–2072. For a conflicting view see the Editorial comment in the same issue, pp. 2096–2097.CrossRefGoogle Scholar
29. Miles, Crimmins. Orders to limit resuscitation. 525–527.Google Scholar
30. Kranson v. Valley Crest Nursing Home, 755 F 2d 46 (3rd Cir 1985).Google Scholar
31. Office of Technology Assessment (OTA): Life-Sustaining Technologies and the Elderly. Washington, DC: US Congress, 1987; OTA-BA306:167–201.Google Scholar
32. Tresch, DD, Thakur, MD, Hoffman, RG, Olson, D, Brooks, HL.: Should the elderly be resuscitated following out-of-hospital Cardiac Arrest. Am J Med 1986:145–149.Google Scholar
33. Bonnin, MJ, and Pepe, P, interview with author regarding the abstract of their study submitted to L'AEM on January 24, 1989.Google Scholar
34. Schiedermayer, DI: The Decision to Forego CPR in the Elderly Patient. JAMA 1988: 260:2096–2097.CrossRefGoogle Scholar
35. Tomlison, R, Brody, H: Ethics in Communication in Do-Not-Resuscitate Orders. N Engl J Med 1988: 318:43–46.CrossRefGoogle Scholar
36. Blackhall, IJ: Must We Always Use CPR? N Engl J Med 1987: 317:1281–1285.CrossRefGoogle ScholarPubMed
37. Robertson, JA: The Rights of the Critically Ill. Cambridge, Mass.: Ballinger Publishing Co. 1983; 77.Google ScholarPubMed
38. AHA: Standards and Guidelines. 2981.Google Scholar
39. Rozovsky, FA: Consent to Treatment, A Prac-tical Guide. Boston: Little Brown & Co, 1984; 474.Google Scholar
40. Meyers, DW: Medico-Legal Implications of Death and Dying. Rochester, NY: Lawyers Cooperative Publishing Co, 1981; 189.Google Scholar
41. Original ACEP Standards, footnote 1.Google Scholar
42. AHA: Standards and Guidelines. 2979–2981.Google Scholar
43. The Hasting Center: Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. Briarcliff Manor, NY: The Hastings Center 1987; 48.Google Scholar
44. Rizzo: The Living Will. 72–79. An effort to simplify and standardize state laws has been undertaken by the National Conference of Commissioners on Uniform State Laws. Even that effort has, however, been seriously critiqued.Google Scholar
45. Salmone, J: Ethics is EMS: Making choices your patients can live with. JEMS 1989; 14:34.Google Scholar
46. ACEP: Guidelines. Third policy statement.Google Scholar
47. Miles, Crimmins. Orders to limit resuscitation. 527.Google Scholar
48. EMSMA: EMSMA Commentary on withholding treatment: Whose responsibility? EMS Management Advisor 1985; 1:6.Google Scholar
49. Olmstead v United Stales, 277 US 438,48 SC, 564, 72 LEd 44 (1928).Google Scholar