The Case of Jimmy: Out of Hospital DNRs for School-Aged Children
Jimmy is twelve years old, bright, interacts well with teachers and other students, and really likes to go to school. However, his osteosarcoma has advanced to a terminal stage, and he is now enrolled in hospice for good palliative care. Because of his terminal condition, Jimmy and his parents have agreed together with the hospice team that any resuscitation attempt would be unwanted and unwarranted.
An Out of Hospital DNR form has been completed, and James's doctor signed it. When Jimmy's parents presented their request that CPR be withheld if Jimmy's death should occur at school, the school nurse told them that their wishes could not be met. The school board had specifically rejected a policy that would honor DNR requests for students during the time they were the responsibility of the school system. The nurse and the principal reinforced the policy and insisted that EMS would be called to the scene and CPR initiated if Jimmy's condition became critical.
Jimmy was reluctant to attend school under these circumstances, but was committed to getting back into the classroom without having to give up his DNR status. His parents enlisted the help of the ethics committee at the local hospital for the purpose of presenting the argument for a school board policy to honor Out of Hospital DNR requests for students with life-threatening conditions.
As a member of that ethics committee, how would you respond to the following questions?