State protocols make it difficult for emergency medical workers to honor the wishes of patients who do not want to be resuscitated, according to John Beckerman, visiting professor of law and a state-certified Emergency Medical Technician (EMT) in his home state of New Jersey.
State law permits living wills and health-care proxiesthe most common advance directivesto influence the course of patient care only in hospital settings. This is understandable, Beckerman says, since EMTs faced with a patient in cardiac or respiratory arrest cannot interpret a living will or interrogate a health-care proxy to determine the patients wishes.
In a typical pre-hospital emergency involving a patient who has recently suffered cardiac or respiratory arrest, EMTs must try their best to resuscitate the patient unless a do not resuscitate order (DNR), signed by a physician, is immediately available, says Beckerman, a member of a volunteer first aid squad who rides a 12-hour shift on an ambulance most Friday nights. He commutes to New Jersey from Ann Arbor, where he teaches Enterprise Organization, Advanced Civil Procedure, and Legal Ethics and Professional Responsibility.
The problem, he says, is that even when a valid DNR order exists, in an emergency it often is unavailable or cannot be found.
The solution, he says, was enacted into law in Michigan in 1996. It permits a person with a valid DNR order to wear a bracelet that informs emergency workers of the DNR. The law both directs emergency medical personnel not to attempt to resuscitate persons wearing DNR bracelets and it shields them from liability for withholding resuscitative procedures from such persons.
As an EMT and a lawyer, I welcome the advent of the out-of-hospital DNR bracelet. Wider use, he says, would help emergency medical personnel to respect patients wishes and to spare relatives the emotional pain of seeing resuscitation attempts being made on a loved-one who did not want them.