title: Pediatric do-not-attempt-resuscitation orders and public schools: a national assessment of policies and laws.
abstract: Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored.
authors.affiliation: The Children's Hospital of Philadelphia and the University of Pennsylvania, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Kimberly
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Forte
authors.forename: Jean M
authors.initials: JM
authors.lastname: Carroll
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D000293:Adolescent; D000328:Adult; D026686:Beneficence; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000193:education / Q000331:legislation & jurisprudence; D035082:Federal Government; D006291:Health Policy; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006801:Humans; D033242:Minors / Q000331:legislation & jurisprudence; D016134:Organizational Policy; D026684:Personal Autonomy; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D012297:Right to Die; D012449:Safety; D012572:School Health Services / Q000331:legislation & jurisprudence; D012574:Schools / Q000331:legislation & jurisprudence* / Q000592:standards; D013219:State Government; D013334:Students / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires; D019452:Terminally Ill; D014481:United States