Catherine Llwyd

Imagine the following scenario- Anna walked into her doctor’s office struggling for breath. After taking her vital signs the nurse was concerned and immediately called the doctor. Anna was assessed by the doctor and diagnosed with another acute asthma attack, considered serious enough to be admitted to the hospital for immediate care. Before Anna was admitted to the hospital she was forced to sign a "Do Not Resuscitate" form (DNR) This means that if Anna takes a turn for the worse and stops breathing the hospital staff will not take any action to resuscitate her. She thought they were joking. They were not! Anna realizes that she could die in the care of the very people who are supposed to save her life! Signing a DNR form ensures that the hospital will not be held liable for Anna's death!

If Anna refuses to sign the Do Not Resuscitate form, she will be denied admittance to the hospital and not given treatment deemed medically necessary! Feeling like she is between a ‘rock and a hard place’, Anna signs the DNR form so that she can be treated immediately...

This scenario sounds unlikely in Canada, right?

Unfortunately, a policy requiring all patients to sign a DNR form prior to hospital admission was recently in effect at O'leary Community Hospital in Prince Edward Island until complaints were made!

This past year, the O'Leary Community Hospital transitioned from a hospital that provided emergency services to one that now operates as an urgent care facility. Only patients in need of palliative, restorative, convalescent and minor acute care are being admitted to this facility. The term ‘minor acute care’ is in question since the Canadian Medical Association defines Acute Care facilities as providing necessary treatment for brief but severe episodes of illness. It follows that if a person is ill enough to be admitted into an Acute Care Facility, then the word “minor” used in this context with the words “acute care” is an oxymoron.

O’Leary-Inverness MLA Robbie Henderson said “The concern was that if everybody had to sign the DNR form to be admitted to acute care in O’Leary then that’s not the definition of acute care as the general public would perceive it, nor is it as government would perceive it”. Further, he said, “The original criteria for the (DNR) form was that palliative patients or the patient who steadfastly refused to go to another facility based on the recommendation of the physician, but as it seemed to evolve that everybody was having to sign it, it took a while to identify that it was an issue and to come up with the measures to address the problem.”

Health Minister Doug Currie said “Once the concerns were identified I asked my department to go back in and to evaluate the decision on the DNR, and certainly after some good discussions and some good debates, we were able to indicate that the DNR is not part of the initial criteria.”

Why would the decision to make patients sign a DNR form before hospital admittance require “good discussions and some good debates”, one might ask, when The Canada Health Act Annual Report clearly states that "The Ministry of Health is a system of integrated services whose aim is to protect, maintain and improve the health and well-being of Prince Edward Islanders. It further states that (ultimately) "The Ministry is responsible for providing a variety of health services to Islanders to promote and help foster their optimal health, including public health services, primary care, acute care, community hospital and continuing care services," and that "Community Hospitals and Continuing Care Provides acute care services to rural communities and supportive services to adults and seniors in need of continuing care on PEI." In a nutshell, this means that the decision to enforce the DNR policy was contrary to the Canada Health Act.

Further, Section 5.1 of the Canada Health Act provides access to insured health services stating that "Both of Prince Edward Island's hospital and medical services insurance plans provide services on uniform terms and conditions on a basis that does not impede or preclude reasonable access to those services by insured persons" AND Section 5.2 of the Canada Health Act states that insured Canadians have access to hospital services. "Prince Edward Island has a publicly administered and funded health system that guarantees universal access to medically necessary hospital and physician services as required by the Canada Health Act."

Any scenario that includes being forced to sign a "Do Not Resuscitate" form prior to admittance and treatment in a hospital sounds unethical and is not in accord with the Canadian Medical Associations Guidelines. Even seen in the best light, someone used very poor judgment. For any doctor who has knowledge of lifesaving procedures to stand by and watch their patients die is against the Canadian Medical Association's Code of Ethics and is a breach of their fundamental responsibilities as doctors.

Seen in the worst light, it is against our Canadian Charter of Rights and Freedoms, which states in Part I, section 7 that "Everyone has the legal right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice." The application of this Charter (32.1) applies "to the legislature and government of each province." If a life or the lives of many were lost due to this decision, there is a good argument that it is a crime!

The Criminal Code of Canada "requires that everyone who is under a legal duty to act (as healthcare providers are) must act when it is the case that not acting would be dangerous to life." The Code also "requires that physicians and surgeons must act with reasonable skill and care in providing treatment. The DNR policy was not reasonable in and of itself but what compounds the injury is any inaction that might have taken place during this time!

Precedents in Canadian law suggest that a unilateral DNR order can only be justified if the patient is in a persistent vegetative state. This policy was a unilateral decision! For a person who is already in a vulnerable state, feeling ill, disabled and in need of medical care, to be placed in a position where they either sign the DNR form and receive care or they decline to sign and are refused treatment is unconscionable. There is no justification under any circumstances for this policy to be in place! Charter rights would be further violated if a patient did not receive treatment, as the Charter of Rights and Freedoms specifically protects citizens from discrimination on the basis of physical or mental disability.

Wouldn't you like to know...

Who is responsible for making the initial decision to deny life-saving rescuscitation to patients who are in medical distress?

How long was this Hospital policy in effect?

How many patients died after signing this order?

IF the decision was made at one time to deny life-saving treatment, how can anyone be assured that this practice, or lack thereof will not continue?

Mr Currie chooses to leave the decision in the hands of the same Hospital staff who would stand by and watch you die if you needed to be resuscitated!

Would you go to ANY hospital that once required you to sign a DNR form before admittance? # # #