EMT's Given Leeway for 'Do Not Resuscitate' Patients

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Some emergency medical responders in Washington state have been given more legal leeway to refuse to resuscitate terminally ill patients who want to die, as long as the patient has "compelling reasons" and their wishes are willingly and clearly communicated. The "compelling reasons" protocol is the first of its kind in the United States.

MADELEINE BRAND, host:

This is DAY TO DAY. I'm Madeleine Brand.

ALEX CHADWICK, host:

And I'm Alex Chadwick. Coming up: a highly unlikely inspiration in the NBA playoffs.

BRAND: But first, a dilemma. Emergency workers receive a call, they rush to the house of a terminally ill person. That person has said no heroic measures. Well, what should the EMT do? NPR's Martin Kaste reports from Seattle.

MARTIN KASTE reporting:

In 1997, 89-year-old Ida Klebold(ph) was nearing the end of her life, and she made it clear to her daughter, Vera DeRosa, that when the time came she wanted to go peacefully.

Ms. VERA DEROSA (Ida Klebold's daughter): She'd watched every ER program and oh, my god, no way, don't ever let them do that to me.

KASTE: DeRosa promised her mother that she wouldn't let anyone pound on her chest or force a tube down her throat to keep her alive. DeRosa even pinned a Do Not Resuscitate Order to her mother's night gown to make sure there was no mistaking her wishes.

Ms. DEROSA: Unfortunately, all her worst fears became a reality.

KASTE: When Klebold suffered a stroke, the family called 911 to have her taken to the hospital for an evaluation. They told the EMT's that they did not want her artificially resuscitated, but en route to the hospital she was intubated anyway. DeRosa says by the time EMT's and paramedics were done with her mother she was, in DeRosa's words, hooked up to everything.

Ms. DEROSA: The circumvented not only my mother's wishes, but my wishes. And that's what just made me so powerless to - this whole big system is so much bigger than the individual.

KASTE: But as it happened that system was about to change. Sitting in the fire department in the Seattle suburb of Kent, paramedic Roger Matheny recalls that just around the time that Klebold was being resuscitated against her wishes, he was wrestling with the same problem from the point of view of the first responders, usually firefighters with EMT training.

Mr. ROGER Matheny (Paramedic, King County): They don't want to do this. They're human beings. They have elderly parents and grandparents, but they weren't given any choice. So Matheny convinced King County, where Seattle is located, to give EMT's more leeway. The revised guidelines now say that if a victim suffers from a terminal illness and if his family or caregivers say that he would not want to be resuscitated, the EMT's are allowed to stand back.

King County EMT's are unique in the country in that they can make this decision based purely on a verbal request. They don't need to see any paperwork or medical bracelets and they don't even need to call in for approval. Paramedic Sylvia Feder helped Matheny design the new rules. She acknowledges that some people might worry that a sinister family member could trick an EMT into letting someone die. But she says EMT's are watching out for that.

Ms. SYLVIA FEDER (Paramedic, King County): The patient has to look the part. You want to make sure that this isn't, you know, the 22-year-old wife that's saying, oh, yes, you know, he doesn't want to live any longer.

KASTE: King County says so far no one has complained about CPR being withheld, and the guidelines have never been challenged in court. Coming back from a call, firefighter Felicia Beluchay(ph) says she appreciates the trust that the county has placed in her and other EMT's.

Ms. FELICIA BELUCHAY (Firefighter, King County): How wonderful is it for us to be able to come into your house and honor how it is that you want to die. And I think sometimes they want to be resuscitated. A lot of times they don't. So it gives us a lot more latitude to use common sense.

KASTE: And King County EMT's are using this latitude. Feder and Matheny have crunched the numbers for the last few years and published their findings in the annals of internal medicine. According to their study, in cases of cardiac arrest, EMT's operating under the new guidelines are withholding resuscitation twice as often as colleagues working under the old rules. The article suggests that EMT's want to honor families' wishes, as long as they're given the legal protection of formal guidelines.

Mr. BILL : It's a point of discussion frequently, to be honest with you, of how to deal with the situation. And I think this article spurs some additional conversation.

KASTE: Bill Koenig(ph) is the medical director for the Los Angeles County Medical Services Agency. He says there's growing interest in giving families more power in end-of-life situations. And many EMT's already defer to their wishes on an informal basis.

Mr. BILL KOENIG (Medical Director, Los Angeles County Medical Services Agency): But I think it's going to have to happen more formally because it's going to be more frequent too.

KASTE: That's because more people want to die at home. But often, when the time comes, the family still instinctively calls 911.

Mr. KOENIG: And it's not easy, you know, for somebody to watch a family member without asking for help when they pass away.

KASTE: Koenig isn't sure the King County rule is right for every part of the country. But he says no matter what, EMT's have to be better prepared for those cases when people call on them for help, but that help means letting someone die. Martin Kaste, NPR News, Seattle.

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