Prehospital DNR orders: an ethical dilemma

Letters

CJEM 2001;3(1):6

To the editor:

Thanks to Sherbino and colleagues¹ for addressing the important topic of prehospital do-not-resuscitate (DNR) orders. They make a number of excellent suggestions, including the need to develop clear policies, adopt standard DNR forms, improve public education and improve the emergency medical technician's (EMT's) access to on-line control.

A significant problem is the lack of published data on Canadian emergency medical services policies. In British Columbia a standard DNR form has been developed, and EMTs are authorized to honour it in the field.² Nova Scotia is now developing policies to allow paramedics to honour DNR forms. At present, they have access to on-line control and may honour a DNR form with base physician approval. Other provinces may have similar policies but few are published, leaving each region to reinvent the wheel. Ontario has unique problems related to specific legislation. With a forum like CJEM, emergency medical services (EMS) directors and policy-makers could share their experience with others and address these problems at a national level.

Merril Pauls, CCFP(EM), MHSc
Department of Emergency Medicine
Queen Elizabeth II Health Sciences Centre
and Dalhousie University
Halifax, NS

References

1. Sherbino J, Guru V, Verbeek PR, Morrison LJ. Prehospital emergency medical services' ethical dilemma with do-not-resuscitate orders. CJEM 2000;2(4):246-51.
2. Innes G, Wanger K. Dignified death or legislated resuscitation? [editorial]. CMAJ 1999;161(10):1264-5.