Legal issues associated with the use of do not resuscitate orders in US schools

Abstract

Do not resuscitate (DNR) orders generally are directives prepared by physicians at the request of parents to cease or deescalate life-supporting services based on a medical diagnosis that a child has reached a terminal condition where he or she can no longer make decisions for themselves and have no medical probability of recovering from their comatose or vegetative state. Such DNR orders, however, raise critical issues about the authority of parents and medical professionals to make decisions for children who often are not in a mental or physical state to comprehend the nature of the DNR order, the rights of children to continued life despite their debilitating or terminal conditions, and the responsibilities of school personnel to implement a DNR order that may result in greater impairment or death for a student. Litigation involving DNR orders has almost invariably focused on minor children in medical settings although medical and nursing publications have provided considerable advice concerning emergency care in schools. However, most of these publications tend to address life-threatening medical emergencies to students in general in the context of limiting liability, with limited focus on the continuing and persistent needs of disabled students. The purpose of this article will be to examine some of the policy issues connected to the appropriateness of DNR orders in school settings, especially as they impact students with disabilities.