April 16, 2012
QUESTION: We have an AED (automated external defibrillator) at our church, but don’t know what to do if someone has a terminal illness and may not want to be resuscitated. What should we do?
ANSWER: Well, as Good Samaritans who tried to help, you probably would be forgiven by the person you helped – eventually! But as compassionate people of faith, you probably want to do the thing that causes the most beneficence, also known as the least harm. So, what to do?
First of all, your AED should only be used by those who are trained to use it, and these typically are members of the health committee and/or the ushers. In some states, such as Wisconsin and South Dakota, people who have a “Do Not Resuscitate” order, which they have discussed with their doctor, may have a special bracelet (called a “Comfort Care” bracelet in South Dakota) which states that they only want to be kept comfortable, but do not want any resuscitation attempts from healthcare professionals. Other states, such as Oregon and Washington, have a POLST document, which stands for “Physician Ordered Life-Sustaining Treatment.” Again, this is information that would have been discussed between the patient and the physician. The bright red form on which this information is documented is generally kept in a visible place (such as the fridge door) in a person’s home, but where would you find it at church, and does it apply to non-medical personnel?
According to Gretchen Brauer-Rieke, RN, MSN, Certified Advance Care Planning Facilitator, the POLST form does NOT apply to non-medical personnel, and the person may or may not have a copy of the form with them to inform people of their wishes. It would be best if a parish nurse talked with anyone known to have a terminal condition to inquire about Advance Directives and other forms such as a POLST, and asked to keep a copy of the forms in a sealed envelope in his/her church office. In addition, the parishioner should have a sign (such as a Do Not Resuscitate designation on the back of their name tag) that the ushers would be trained to look for before using the AED. It would be the responsibility of the person to wear the agreed-upon “signal.” Of course, in all cases where someone has collapsed, 911 should be called, and in the cases of states with a POLST-type registry, if the EMT has the person’s name, they can often look them up en route to see if they have made known their wish not to be resuscitated.
Removing clothing to use the AED, breaking ribs through compressions of CPR and causing enough recovery to survive on a ventilator may absolutely be against the wishes of someone with a terminal illness. Education of church-based first responders should include information, along with a policy and procedure for compassionate care of people at all stages of life.
Here is an AED Use Refusal Form, provided by Gretchen Brauer-Rieke.