DNR For Disabled Child at SCHOOL?
I had to think about this, but I think the parents' decision to order their profoundly disabled daughter not to receive CPR at school if she has a cardiac arrest is very wrong. From the story:
As the school bus rolled to a stop outside her Lake County home, Beth Jones adjusted the bright yellow document protruding from the pouch of her daughter's wheelchair, making sure it was clearly visible. In bold letters it warned, "Do Not Resuscitate." The DNR order goes everywhere with Katie, including her 2nd-grade classroom at Laremont School in Gages Lake. The school is part of the Special Education District of Lake County, where an emotional two-year discussion ended this summer when officials agreed to honor such directives.I have great sympathy for the parents and I am certainly not against DNR orders per se. But this isn't just something that would necessarily be "on their own terms." It could also involve other people; the school administration, teachers, and most importantly other students and their parents who would have to deal with the trauma that could be caused by seeing a classmate die in front of their eyes.
Now, district officials find themselves in the unusual position of having planned the steps its staff will, or won't, take to permit a child to die on school grounds. Although DNR orders are common in hospitals and nursing homes, such life-and-death drama rarely plays out in schools, where officials realize how sensitive and traumatic the situation could be for nurses, teachers and students. The scare [an earlier episode in which she stopped breathing] strengthened Beth and Dave Jones' resolve to face the death of their daughter on their own terms.
The story says that Katie enjoys going to school:
On a recent morning, Beth Jones could readily see how keenly her daughter enjoyed her trips to school. The little girl was beaming up at her from her wheelchair as they waited for the bus. "You're in a really good mood, aren't you?" Beth Jones asked her.It strikes me that if it is important for Katie to go to school--which it certainly seems to be--then the Jones family should think about the impact allowing Katie to die would have on others. At home, in a hospice, in a hospital, a DNR order could be proper. But I don't think such orders should extend into the realm of the general public. At that point, the presumption for life should prevail.
HT: Vickie McKenna
Labels: DNR
posted by Wesley J. Smith @ 11:05 AM
9 Comments
9 Comments:
Goodness, they don't live in a bubble! Sigh. I think they should recognize the problems the DNR order would have on the other students, visitors, staff, and everyone else associated with the school, should the child have another scare or actually start to die on campus. I can comprehend their feelings, but as long as their child is part of the community they should try to think outside their nuclear group and relaize how they're going to affect everyone.
Dying in school, where most of the staff and kids don't know you and where you can't have any kind of pain relief as your body shuts down isn't the best way to go. And it's not so great for the frightened children who might be stuck watching you die. Nor for your teachers.
I'm not saying I'm against the DNR for the child - just, if she has an episode in school, have her stabilized, removed to a hospital, and then have things go from there, to minimize the trauma to both her and to her peers and teachers.
Two thoughts come to mind here:
1. A do-not-resuscitate order is binding only on medical personnel in a hospital or other medical facility. It does not apply to laymen at the school, and it explicitly does not apply, for example, to rescue personnel, so an ambulance crew called to the school would still have to try to perform CPR on the girl if she goes into cardiac arrest. In fact, the crew have a legal obligation to do this.
2. The girl is well enough to go to school—not on death's door, in other words—so why are the parents pushing this DNR order in the first place? Something smells mighty fishy to me. Maybe the parents want the girl put out of their misery if an emergency happens.
In fact, she might be in some danger. Just my opinion, but does anyone care to lay odds on the possibility that the girl will be found dead in the parents' hot car after they "forget" she's in there on a hot day? My hunch is that something like that is coming.
K-man: Thanks for stopping by. I agree with your first points but definitely not your second. Katie has a feeding tube. If the parents really wanted her dead sooner rather than later, they would be able to dehydrate her to death by withdrawing medical treatment. From what I read, they are sincerely worried that being resuscitated will cause her increased suffering. I think we should be careful before charging people with such indifference.
Wesley, thank you for clarifying the fact that Katie is on a feeding tube. I have to admit,I too wondered about her safety. I am sure the parents love her....but I would imagine the stresses of their daily life might get to be more than they "feel" they can handle! People often do things that they would not under normal circumstances. ( Whatever "normal" is! :) )
I'm all for Katie being at school or whatever makes her happy.
But my second-grader would not be in her class. I can only imagine the trauma the children would experience if they saw her in some sort of crisis, then taken away, where they knew nothing would be done to save her life. Looking back to my daughter at age 7, I can tell you she would have had a very hard time getting over that.
"Katie has a feeding tube. If the parents really wanted her dead sooner rather than later, they would be able to dehydrate her to death by withdrawing medical treatment. From what I read, they are sincerely worried that being resuscitated will cause her increased suffering."
See, that's why I'm not upset about the DNR itself because it does make sense in a way: they're probably thinking, "if she has a serious episode and *is* near death's door, odds are if they resuscitate her she'll be in agony briefly before dying." But it weirds me out that they'd push this at the school, because the situation is so different there than it is in a hospital or at the house. There are too many vulnerable people there who aren't trained to handle death and dying the way medical staff is, and the students and staff aren't her loved ones, meaning she'd be put under pressure if something happened, too, which in its own way might be agonizing.
But if she's well enough to go to school and the odds of an episode happening are low or unlikely, then I also understand why they're sending her to school. It's tricky and a little hair-pulling, because this is a case of people who are doing the best they can. I just think they're too weighed down by their own problems and should consult an outside source for guidance in this case. A disintrested third party is always a good choice for advice before making your final decision in a case like this.
Wesley, thanks for the clarification about Katie Jones's feeding tube and her parent's concern about her during lifesaving measures. But isn't stopping "suffering" the same argument Robert Latimer in Canada used to kill his daughter directly?
Just who is "suffering", Katie or her parents?
We live in an era when fetuses routinely are aborted for Down's syndrome and other defects. There was some stink in bioethical circles over a British woman choosing to abort because the fetus had a cleft palate, a condition routinely corrected by surgery.
It doesn't take much imagination to realize that this process is likely extended to disabled, retarded, or just plain unwanted children through fatal "accidents" or "medical events". (Note that we don't hear very much about sudden infant death syndrome (SIDS) since shaken-baby syndrom became well known; infants simply die in hot vehicles instead. Where there's a will, there's a way.) Trying to push a DNR order on a school still seems to me tantamount to wished-for death by proxy. Instead of bowing to the parents' wishes, the school should be calling child protective services to investigate Katie's safety.
Maybe her parents' concern about her suffering during resuscitation is genuine. And maybe after the girl is gone, they'll be crying "genuine" crocodile tears as well. Just my opinion, and sorry to be so cynical, but I've seen enough of the disposible-disabled philosophy that you rightly decry.
K-Man: I take no back seat to anyone in my disrespect for Robert Latimer. But I don't see this case in that light. I agree with you that disabled people face terrible discrimination in the area of medical treatment. The ADA needs to be amended to include medicine in its parameters. But I don't want to slam the parents. They seem to love her a lot and we don't know enough to make a judgment to the contrary. Thanks for stopping by.
K-Man said.."do-not-resuscitate order is binding only on medical personnel in a hospital or other medical facility. It does not apply to laymen at the school, and it explicitly does not apply, for example, to rescue personnel, so an ambulance crew called to the school would still have to try to perform CPR on the girl if she goes into cardiac arrest. In fact, the crew have a legal obligation to do this."
This is explicitly wrong. You are correct about the legal obligation, but it is to honor the DNR order. Any resuscitation effort would be terminated on the arrival of Advanced Life Support.
There are protocols for such things, just like in the hospital.
On the DNR order, there are usually options. These can range from no efforts at all, no airway, no IV access, or all but CPR. I have seen many orders that allow for all efforts except CPR. This allows for some latitude. DNR does not have to be cut and dry, and should not be oversimplified..
Everyone, healthy adults included, should have some sort of advanced directive, living will, or resuscitation orders. It is the only responsible thing to do, and it takes the onus off of family to make the difficult decisions.
If you have ever seen CPR in progress, not TV CPR, real CPR..You may rethink your position..
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