Program Permits Rejection of Lifesaving Efforts

When death is imminent, 81-year-old Dr. Eleanor Johnson does not want a paramedic to take any extraordinary measures to keep her alive.

Under a new county program, she can make her wishes clear.

Participants in the program, launched two weeks ago, can receive identification bands for wrist or ankle and “Do Not Resuscitate” documents instructing emergency personnel to forgo lifesaving measures on the bearers.

“I’ve been treated for a heart condition for 10 years, my eyesight is failing and I get out of breath when I walk my dog,” said Johnson, a retired physician from Camarillo. “We spend too much money keeping older people alive and too little on the younger ones, since most of the money spent to prolong life is useless.”

Barbara S. Brodfuehrer, administrator of the county’s emergency medical services department, said the forms will give people the same right to reject treatment in emergency situations that they are granted in hospitals.

“It lets people express their wishes ahead of time,” Brodfuehrer said. “Not providing treatment is helpful if that’s what someone wants.”

The department adopted the program in part to relieve problems for ambulance personnel who are sometimes asked by relatives or the patient to refrain from taking extraordinary measures.

“The 911 emergency personnel were traditionally required under state law to administer the total spectrum of services they have available the minute they’re called,” said Peter Forchheimer, chairman of the Ventura County chapter of the Hemlock Society, a right-to-die advocacy group. “The patients had no say. If you called 911, you got the works.”

At least a dozen California counties have adopted DNR programs for emergency situations since Congress passed the Patient Self-Determination Act of 1990, said Angelina Mendoza of the California Emergency Medical Services Authority. The law gave patients the right to determine their own course of treatment, she said.

Orange County issues bands only to the terminally ill, while Ventura County and others make no stipulation about a person’s state of health.

“We’re finally coming to a position of acknowledging that people have a right not only to choose what needs to be done to them in order to correct an illness, but even if an illness should be corrected,” said Dr. Peter Gaal, a Ventura surgeon and ethics committee member at both Ventura County Medical Center and Community Memorial Hospital.

State Sen. Mike Thompson (D-St. Helena) has introduced a bill scheduled for public hearing Tuesday that would relieve counties of liability for honoring emergency DNR forms. Some counties have not adopted a DNR program for fear of being sued if treatment is withheld, said Tom LaFaille, Thompson’s legislative assistant.

The bill would also designate a single authorization form and bands to be accepted across county lines, he said.

The Ventura County department sent letters March 20 to more than 450 doctors notifying them of the program. Doctors will have to sign for the forms to be validated, a measure intended to ensure that the person discusses the ramifications with a medical professional.

Patients may get the forms from their doctors or the county emergency medical services department.

State guidelines may be amended to allow an individual’s signature to suffice since some doctors may be inclined for religious reasons not to sign a form on their patient’s behalf, Mendoza said.

Brodfuehrer said her office had sent out about a dozen forms by Wednesday to doctors inquiring for their patients. Only one DNR request has been submitted so far.

Johnson, a Leisure Village resident, said she has not yet applied for her wristband but will do so at her next doctor’s visit.

“I’m trying to keep my Medicare expenses to a bare minimum,” Johnson said. “When I go in to get my prescription for nitroglycerin refilled, I’ll ask him then.”