Limiting resuscitation: Emerging policy in the emergency medical system

Article Abstract:

In recent years, health care professionals have recognized that a patient's decision to forgo resuscitation in the event of cardiopulmonary arrest should be respected. Formal policies regarding 'Do not resuscitate' (DNR) orders are the norm, but these apply and are honored almost exclusively at the institutions at which they are written. Emergency medical service (EMS) workers face conflicts between a patient's wish for DNR status and state, local, and ambulance agency regulations that require that cardiopulmonary resuscitation be administered to all patients who need it. A study was done to assess what policies currently exist that permit EMS workers to honor DNR orders. A survey of all 50 states plus the District of Columbia was made; all EMS offices that were contacted participated. State regulations that permit the honoring of pre-existing DNR orders were reported in eight states. Another 21 EMS systems have made provision for orders to withhold life-sustaining treatment if so directed. Only Montana provides civil and criminal immunity to EMS workers who withhold resuscitation in accordance with pre-existing DNR orders. A total of 21 different procedures for DNR orders were reported, along with three procedures used by EMS teams to verify DNR orders at the patient's primary care site. One conclusion which may be drawn from this survey is that a simplified and streamlined DNR policy is needed nationwide. Some of the barriers that prevent unifying policies on EMS and DNR orders include logistic difficulties of coordinating DNR status among all the health care providers involved with patients, and legal concerns such as malpractice liability. DNR orders should be honored, but patients should not be denied other emergency medical services. Intrainstitutional DNR policies need to be established. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Montana, Ethical aspects, CPR (First aid), Cardiopulmonary resuscitation, Living wills, Emergency medical technicians

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Now is the time: physician involvement in health care reform

Article Abstract:

Physicians as individuals should play a more active role in health care reform. While various physician organizations have joined in the debate on how to increase consumers' access to health care and how to control the costs, physicians have a unique opportunity to get involved within their own communities and shape the outcome of the reform movement. There are four principle ways in which doctors can help. First, they can become more knowledgeable of current proposals and more understanding of their patients' dilemmas. Second, by working to dispel unrealistic expectations of the health care system, they can help curb costs. Third, by opening up their practices and exposing medical students and residents to community medicine and clinical thinking, they can help in the reformatting of medical education. Finally, they can work towards redefining success in the health care system in terms of society's well being and not just individual patient outcomes.

Social aspects, Editorial, Political activity, Physicians, Medical professions, Health care reform

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The Health Effects of Economic Sanctions and Embargoes: The Role of Health Professionals

Article Abstract:

The authors present the position of the American College of Physicians and the American Society of Internal Medicine on the roles of physicians relative to health effects caused by economic sanctions. While often cheered as an alternative to military action to force a nation to end a war or halt an abuse of human rights, in many ways, the difference is that with an embargo, the civilian casualties are not as visible. While the United States does maintain embargoes on countries such as Cuba, it also tries to influence policies by other economic methods such as favored nation status.

Political aspects, Economic sanctions, Sanctions (International law)

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