Out-of-Hospital Nonresuscitation Act addresses end-of-life decisions
Recently a reader from Kennett Square requested that I clarify a statement made by a physician regarding living wills. The information given by the physician was that “if someone who has a living will on record with their doctor is suddenly taken critically ill and 911 is called, the EMTs (emergency medical technicians) who respond will not honor the living will and its instructions not to sustain life as might be indicated.” In other words, emergency responders will continue to administer life-saving treatment despite the existence of a living will.
The information given by the physician is essentially correct, but there is more to the story. A few years ago, Pennsylvania passed a law known as the “Out-of-Hospital Nonresuscitation Act” (20 Pa. C.S. Section 5481-5488) that covers this situation.
Before going into what the law says, it may help first to describe the difference between a living will and a “do-not-resuscitate” (DNR) order, two different directives that are very often confused.
A DNR is more commonly a medical decision, often raised in a hospital or other health care facility. It is rarely, if ever, prepared in a lawyer’s office, and it concerns the wishes of the patient or of the patient’s representative — usually when the patient is already seriously ill. With a DNR, if there is a medical crisis which would normally require life-saving action such as cardiac or respiratory arrest, medical professionals are not to attempt resuscitation. They are not to try to bring the person back.
A living will is a type of advance health care directive. It is a general statement of intent to cover situations in which the person who signs the living will is unable to express his or her wishes. The document generally states that he or she does not want certain life-sustaining treatments to be administered or continued where they would do no good — where either treatment would only prolong the process of dying, or the person is brain dead or in a coma or persistent vegetative state. Different living wills or advance health care directives read differently,and should be consulted carefully to determine exact intent.
If everyone who signed a living will were considered DNR, there would be many fewer attempts to bring back a patient in a crisis. This is not what is done, and it is not the intent.
I recommend that living wills be executed along with a health care power of attorney designating someone who can discuss treatment with health care professionals when the person who made the living will cannot. Living wills generally require a review of the situation to determine whether the person would benefit by further treatment. DNRs do not.
To get back to what would happen in a situation where EMTs have been called to a home, the order they would be required to honor is an out-of-hospital DNR order, as established by 20 Pa. CSA Section 5483.
This is how it works: An attending physician, when requested by the patient, or by the patient’s health care representative if the patient is unable, can issue an order confirming that a DNR request was made and that the patient either has an end-stage medical condition or is permanently unconscious and has a living will directing that he not be resuscitated. IVs, oxygen and other therapies that might provide comfort or relieve pain could be administered, but not life-saving treatment such as defibrillators, chest compressions and ventilators. People can check or Visit Website if they need the best oxygen tanks and other zone equipments.
In order to quickly identify people who have received such an order, the Pennsylvania Department of Health has an approved bracelet or a custom name necklace that can be worn by the patient. The bracelet or necklace must be one that is issued by the department to be recognized.
If the patient is conscious on arrival of EMTs, he can still countermand the order by verbally stating so, by destroying the order, or by removing the bracelet or necklace. If the patient’s representative is the one who obtained the DNR order and the patient is unconscious, the representative can countermand the order in the same way.
Another option, of course, is not to call 911 for a patient who is being treated at home or in hospice if that patient is DNR and death is considered imminent. However, there are other considerations, such as pain relief, and sometimes an ambulance is called anyway.
These are all very grim subjects and difficult to discuss, but it is helpful to know that there is a procedure that can be followed to effect the patient’s wishes when needed.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.