Missouri passes out-of-hospital do not resuscitate measure
Allows for patient to decline CPR
May 22, 2007
CONTACT: Lorell R. LaBoube, (816)221-1100 Ext 239
llaboube@practicalbioethics.org
A measure allowing individuals to decline CPR in locations outside the hospital has been passed by the Missouri General Assembly. Adoption of the law reflects a growing trend among states nationwide.
“In many cases, it is ill-advised for patients to be subjected to the trauma of CPR,” states John Carney, vice president for aging and end of life at the Center for Practical Bioethics. “This measure not only recognizes the need to protect the health and safety of the patient, but also in many cases honors the wishes of a terminally ill patient at home.”
Carney says research indicates many frail elderly, especially those living in nursing homes, benefit little from the technology offered by emergency rooms and intensive care units. “Too much technology too late in the course of illness actually impedes good outcomes and interferes with quality,” says Carney.
The bill requires the do not resuscitate (DNR) order to be on the first page of the medical record for a patient residing in a facility. A patient, the patient representative and the attending physician may initiate the order. Only cases involving CPR are affected by the new law; it will not authorize withholding or withdrawing other medical interventions such as intravenous fluids, oxygen or other therapies.
A first responder would still be required to apply CPR if a patient or representative expresses a desire to be resuscitated before or after the onset of cardiac arrest.
Along with Missouri state officials, a representative group of stakeholders who worked for the adoption of the law will develop regulations and forms to enact the measure over the course of the next year. Carney says this process will enable emergency medical technicians, paramedics and first responders to work on uniformity in how these cases are handled.
Carney says this law is an important first step. “Hospitals are marvelous places for sick people who can recover,” says Carney. “As our society ages we’ll grow more comfortable with addressing end of life options that are more consistent and supportive of good end of life care outside of acute care institutions. This kind of legislation recognizes that shift.”
Link: Outside the Hospital Do-Not-Resuscitate Act
The Center for Practical Bioethics is a nonprofit, free-standing and independent organization nationally recognized for its work in practical bioethics. Since 1984, the Center has helped patients and their families, healthcare professionals, policymakers and corporate leaders grapple with ethically complex issues in medicine and research.
