The Akron Legal News

Legislation designed to clarify do-not-resuscitate directives

TIFFANY L. PARKS
Special to the Legal News
Published: September 15, 2014

Prompted by a pattern of inconsistent interpretation, Sen. Peggy Lehner has introduced a bill into the Ohio General Assembly that would sunset Ohio’s Do-Not-Resuscitate Comfort Care protocol and calls for the use of Medical Order Life Sustaining Treatment or MOLST forms.

“Though DNR protocol was intended to offer a portable DNR that would be honored across care settings while offering immunity to health care providers in the withholding of cardiopulmonary resuscitation, DNR-CC protocol has been inconsistently interpreted,” said Lehner, R-Kettering.

“Health care workers are still experiencing confusion between DNR Comfort Care and DNR Comfort Care/ Arrest protocol, and many patients are unaware that they can refuse CPR, or believe that the living will document acts as DNR-CC designation without a physician’s order.”

Senate Bill 347 was crafted to address the inconsistency.

The proposed legislation would authorize the use of a MOLST form.

The form details instructions, issued by a physician, physician assistant, certified nurse practitioner or clinical nurse specialist, for how a patient should be treated with regard to hospitalization, administration or withdrawal of life-sustaining treatment and comfort care, CPR administration and other treatment outlined in Ohio law.

Lehner said MOLST is for patients suffering from terminal illness or elderly patients who may die within the next year and who wish to avoid or receive any or all life-sustaining treatment.

“These patients specify through the MOLST form their preferences regarding how he or she wishes to be treated,” she said.

“MOLST is neither an advance directive nor a replacement for advance directives, but will serve as a complement to existing advance directives as a translational tool to assure the continuity of care.”

The bill would adjust the current definition of a “do-not-resuscitate order” to mean a written directive issued by a physician prior to or no later than six months after the effective date of the amendment in accordance with the do-not-resuscitate protocol that identifies a person and specifies that CPR should not be administered to that individual.

SB 347 defines “CPR” as cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, but states it does not include clearing a person’s airway for a purpose other than as a component of CPR.

If the bill is enacted, emergency medical services personnel, physicians and health care facilities would have immunity from criminal prosecution, liability in damages in a tort or other civil action for injury, death or loss to person or property, or professional disciplinary action arising out of or relating to the withholding or withdrawal of CPR from a person after DNR identification is discovered in the person’s possession and reasonable efforts have been made to determine that the person in possession of the DNR identification is the person named on the identification.

SB 347 also offers protections to individuals and facilities who provide CPR after an individual who is in possession of DNR identification makes an oral or written request for treatment.

The measure states that in an emergency situation, EMS personnel are not required to search an individual to determine if the person possesses DNR identification.

Under the bill, physicians would not be granted immunity for issuing a DNR order that is “contrary to reasonable medical standards.”

“The bill also provides that a MOLST can be revoked by the patient or patient’s representative at any time,” Lehner said.

The MOLST form, which would be posted on the Ohio Department of Health’s website, states that there is no requirement that a patient execute the form and that each patient shall be treated with dignity and respect.

“Attention shall be given to the patient’s needs,” the form reads. “The duty of medicine is to care for the patient even when the patient cannot be cured. Moral judgments about the use of technology to maintain life shall reflect the inherent dignity of human life and the duty of medical care.”

Lehner said the bill would not change current state law that limits when an agent can authorize medical personnel to withdraw artificially or technologically-supplied nutrition and hydration, and specifically clarifies that the Revised Code does not authorize mercy killings, assisted suicide or euthanasia.

“The bill also requires a task force to report, after five years of MOLST implementation, to the General Assembly any suggestions or changes to the form or legislation,” she said.

SB 347 is co-sponsored by Republican Sens. Shannon Jones, Bill Seitz and Joe Uecker.

The bill is awaiting a committee assignment.

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