CREATING A DIGNIFIED OPTION - ETHICAL CONSIDERATIONS IN THE FORMULATION OF PREHOSPITAL DNR PROTOCOL

Increasing numbers of states are recognizing the importance of develop ing policies to allow Do Not Resuscitate (DNR) orders to he recognized in the prehospital setting, especially by emergency medical personnel . The ethical issues involved in creating such policies have not been widely addressed. Using the experience of developing such a policy for the District of Columbia as a model, we discuss six major ethical iss ues involved in prehospital DNR order policy development. 1) Can the j ustification for the policy be grounded in the doctor's duty or benefi cence? 2) Should the concept of futility he applied to prehospital DNR orders? 3) How specific should prehospital DNR orders be? 4) How can one maximize patient participation in the prehospital DNR decision? 5) How much consideration ought to be given to the scarcity of health ca re resources in the development and justification of such policies? 6) Should paramedics be empowered to pronounce DNR patients dead in the field? This discussion ought to be of benefit to all those involved in developing or revising prehospital DNR policies. ((C) 1995 by W.B. Sa unders Company)