End-of-Life Decision Making

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Which of the standards for health services in jails and prisons speak to advance directives and do not resuscitate orders?

Advance directives and do not resuscitate orders are addressed in standard F-07 Care for the Terminally Ill. The standard states: “The facility addresses the needs of terminally ill inmates, including protecting their rights regarding end-of-life decisions.” One of the compliance indicators is that “advance directives, health care proxies, and DNR orders are available when medically appropriate.”  Those options are often overlooked for our patient population. Those approaching the end of life may face many profound issues. This NCCHC standard states that they have the right to receive life-sustaining treatments, if desired, or not to have the dying process prolonged, if that is their wish.  

— From CorrectCare Volume 34, Issue 2, Spring 2020

 
 

In our prison, terminally ill inmates are sent to a community hospital where the admission procedures enable them to execute a DNR (do not resuscitate) order that the hospital would follow. However, if the inmate improves and returns to the prison, the DNR orders are not honored. If necessary, emergency, life-saving interventions are initiated before transport back to the hospital. Are we in compliance with important standard P-I-04, End-of-life Decision Making?

This question was taken up recently by the Accreditation Committee, which decided that in the circumstances above, the intent of the standard is not being met. Though it is possible for the inmate to be returned to a hospital setting as death approached, it also is possible that a life-threatening emergency requiring CPR and related interventions would occur in the prison and the inmate would be subjected to measures explicitly declined in the DNR order before or during transport to the hospital.

Standard I-04 intends that inmates retain their medical-legal rights regarding end-of-life decisions. Therefore, facilities or systems considering denial of an inmate’s right to execute a DNR order should check with their appropriate legal counsel (state or county) to determine whether the directive is in compliance with the jurisdiction’s regulations on this matter.
— From CorrectCare Volume 18, Issue 4, Fall 2004