Peacock Tales • Summer 2014

Out-of-Hospital Nonresuscitation

“Do not resuscitate;” these three words are responsible for a great deal of controversy. Some, like the late comedian George Carlin joked, “Leave my plug alone . . . get an extension cord for my plug!” While others, like eighty year-old great grandmother and former nurse, Mary Wohlford was so serious about the subject that she had the term tattooed on her chest. While most of our opinions lie somewhere between these two extremes, what one cannot deny is that more and more, people are making the decision to forego such treatment, so many in fact, that states have adopted legislation to regulate the choice.

An area that might escape contemplation of many, however, is how such a decision can be expressed, short of a tattoo, outside of the hospital setting. Pennsylvania lawmakers addressed the subject and the result is the Out-of-Hospital Nonresuscitation Act. The legislature has recognized that in many cases, resuscitation may cause unwanted further suffering. A health care power of attorney/advance directive/living will does not pertain to emergency health care providers. The Act gives direction to emergency medical services personnel, such as EMT’s and emergency health care providers. It permits certain individuals to get what is called an “out-of-hospital do-not-resuscitate bracelet.”

An out-of-hospital do-not-resuscitate bracelet is a necklace or bracelet supplied by the Department of Health through the patient’s treating physician. It notifies emergency medical services providers of the patient’s wishes.

You must be 18 years of age, have graduated from high school, be married or be an emancipated minor to request a bracelet. You must also have either an end-stage medical condition or be permanently unconscious. According to the Department of Health, “‘permanently unconscious’ is a medical condition that has been diagnosed in accordance with currently accepted medical standards and with reasonable medical certainty as total and irreversible loss of consciousness and capacity for interaction with the environment. The term includes, without limitation, a persistent vegetative state or irreversible coma.” 
The individual may request their treating physician to issue an order which directs emergency medical services personnel to withhold resuscitation from the individual. It may also direct such personnel to provide some medical intervention to provide comfort or to alleviate pain as the person expires. The order is not permanent and can be revoked. Additionally, a surrogate may request the order if the person is unable to do so for themself.

A “surrogate” is a health care agent or health care representative under a valid power of attorney. The Act also permits a parent of a minor or a court-appointed guardian, to request the order. Before an order can be acquired, the determination must be made whether a potential surrogate has legal authority to request such an order.

Of course, the individual must wear the bracelet or necklace, which bears the words “PENNSYLVANIA OUT-OF-HOSPITAL DNR,” the name of the patient, the physician and the dated signature of the physician. It is similar in appearance to a hospital identification bracelet.

No one enjoys the prospect of having to acquire such an accessory. However, if wishes are to be respected, the bracelet is a tool to fulfill these wishes and minimize further suffering.

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