Child/Adolescent Health

Do-not-resuscitate orders for terminally ill children may not be honored by public schools

Some children attending public schools have terminal illnesses, but when they and their families determine that resuscitation in the event of cardiopulmonary arrest would not benefit them, there is no guarantee that do-not-attempt-resuscitation orders (DNARs) will be honored by public schools.

Researchers at The Children's Hospital of Philadelphia and the University of Pennsylvania, supported in part by the Agency for Healthcare Research and Quality (HS00002), surveyed prominent school districts in 81 U.S. cities about written policies or procedures for student DNARs. They then compared school policies with relevant State laws from all 50 States and the District of Columbia on out-of-hospital DNARs, advance directives, living wills, and the provision of health care to minors in public schools. Most (80 percent) of the school districts surveyed did not have policies, regulations, or protocols for dealing with student DNARs. Also, 76 percent either would not honor student DNARs or were uncertain about whether they could.

Only 16 public school districts (20 percent) reported having a policy, rule, or procedure explicitly concerning the honoring of student DNARs. Among those, 10 prohibited school personnel from honoring student DNARs, while the remaining 6 allowed it. Frequent contradictions between school policies and State laws also exist. Seventeen States and the District of Columbia provide statutory authorization of advance health care decisions for minors. Yet only 5 of these 18 jurisdictions have laws providing legal protection against criminal or civil liability to school personnel who, in honoring a student's DNAR, do not attempt resuscitation. Also, 13 of the 19 school districts that honor student DNARs reside in States that have no laws to protect school personnel from criminal or civil liability for withholding CPR.

See "Pediatric do-not-attempt-resuscitation orders and public schools: A national assessment of policies and laws," by Michael B. Kimberly, Amanda L. Forte, Jean M. Carroll, B.S.N., and Chris Feudtner, M.D., Ph.D., M.P.H., in the Winter 2005 American Journal of Bioethics 5(1), pp. 59-65, 2005.

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