The Need for a Prehospital DNR System

Abstract

Initiation of cardiopulmonary resuscitation when the death is the result of an end-stage, irreversible, and imminently terminal illness against the patient's prior request is immoral and indefensible. Medical providers should withhold treatments that are futile, and individuals have the right to refuse this invasive therapy.The use of Do-Not-Resuscitate (DNR) orders has become a standard of medical care in health care institutions and should be incorporated into the prehospital medical care system. The American College of Emergency Physicians (ACEP) supports their use, and the National Association of Emergency Medical Services Physicians (NAEMSP) has developed a consensus paper endorsing the use of prehospital DNR orders. The Joint Commision on the Accreditation of Hospitals (JCAH) recommends the use of DNR orders and the American Heart Association (AHA), in Standards and Guidelines for Advanced Cardiac Life Support, recognizes their validity. It is time for EMS systems to develop and implement policies and procedures, with adequate safeguards, to allow the withholding of CPR in specific circumstances. The claim that DNR orders cannot be honored in the prehospital setting is a self-fulfilling prophecy. If an emergency medical services (EMS) system lacks strong medical leadership or believes that a prehospital DNR system cannot work–a communitywide DNR program never will come into existence. Dying patients will continue to suffer the indignity and burden of unnecessary and futile treatments that serve no benefit to the patient and only serve to alienate and anger the family members.