Providing Safe Health Care:
The Role of Education Support Professionals

Appendix: NEA Policy on "Do Not Resuscitate" Orders

In June 1994 the NEA Executive Committee adopted the following policy statement on the handling of "Do Not Resuscitate" orders.

Advances in medical technology now make it possible for some severely ill students to attend school and participate in the learning environment. However, there exists an ever-present threat that such students may go into cardiac/respiratory arrest while in school. In some instances, parents of such students, in conjunction with their physicians, have determined that certain emergency procedures, such as cardiac pulmonary resuscitation, would be too invasive and painful, might cause severe brain damage, or might otherwise result in worsening the student's physical problems. In such a case, the physician will issue a "do not resuscitate" (DNR) order, directing that no life-saving procedures be utilized.

While DNR orders have been common phenomena in hospitals and nursing homes, they have only recently surfaced in several school districts around the country. This has prompted a number of inquiries and requests for guidance from NEA members and affiliates.

Of particular concern is the question whether a classroom teacher or other school employee must obey a directive from the school employer to comply with a DNR order. As a general rule, a school employee always should obey a specific directive from the employer. Since this is a developing area of the law, however, NEA members should consult with counsel at the state level to determine whether any special state laws or policies address this situation.

While many districts honor requests to follow DNR orders, others have refused, and still others require parents to obtain a court order before honoring DNR orders. The Maryland Attorney General, for example, has taken the position that school officials in Maryland must comply with DNR orders, while the Iowa Attorney General has said that a school "has no duty to comply with a decision by parents and the physician to withhold life-sustaining procedures" because a school is not a licensed health care provider under state law.

The proposed policy does not take a position on whether school districts should, as a matter of public policy, honor DNR orders; that is an issue that should be resolved at the state and/or local level. However, in considering a request to honor a DNR order, the school district should consult with counsel to determine what legal rights and responsibilities it has, including the applicability of a collective bargaining agreement.

While requests to honor DNR orders must be handled on a case-by-case basis, NEA recommends that no request be granted unless the following minimum conditions are met:

1. The parents' or guardians' request is submitted in writing and accompanied by a written DNR order signed by the student's primary licensed physician.
2. The school district establishes a "team" consisting of the parents/ guardians, student's physician, school nurse, student's teacher(s), appropriate support staff, and school superintendent or designee to consider the request. The team first considers all available alternatives. If no other option is acceptable to the parents/guardians, then the team develops a "medical emergency plan," which includes the following essential elements:

   a. The plan specifies what actions the student's teacher or other school employee should take in the event that the student suffers a cardiac arrest or other life-threatening emergency, e.g., telephone the local emergency medical service, apply emergency procedures as determined by the team, contact the parents/guardians, evacuate other students from the classroom, etc.

   c. The student wears an ID bracelet while at school indicating that he/she is subject to a DNR order and a medical emergency plan.

   d. The parents execute a contract with the local emergency medical service providing that the service will honor the DNR order; a copy of the contract is made available to the school superintendent/designee.

   e. The team agrees to review the plan and the student's health condition at least on an annual basis.

3. School staff receives the necessary training and counseling, and educational Death and Dying programs are provided for students. In the event the student subject to a DNR order dies, appropriate counseling will be provided to staff and students.