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Withholding Resuscitation or Life-Sustaining Treatment

Introduction

SME: Medical Director
Last Review Date: 6 /6/07

Last Review Date: 10/19/10

Last Review Date: 08/31/11

UTHCPC follows the patient's wishes regarding resuscitative services and life-sustaining treatment. Decisions regarding withholding resuscitative services or life-sustaining treatment are among the most difficult choices facing UTHCPC patients, families, and health care professionals.

Required documentation

The following UTHCPC documents are required for withholding resuscitation or life-sustaining treatment:

Medical Emergencies/Cardiopulmonary Resuscitation

Properly executed Advance Directives
Compliance
: Reference documents comply with the following:

Natural Death Act

The Durable Power of Attorney for Healthcare Act

Texas Law regarding informed consent and the patient's right to accept or refuse medical, surgical, or mental health treatment

Chapter 137 of the Civil Practice and Remedies Code relating to declarations for mental health treatment

Resuscitation services

It is the policy of UTHCPC to provide resuscitation services for all patients except in the following conditions:

An active Advanced Directive regarding a terminal patient is available

A known Do Not Resuscitate (DNR) status exists

Physician responsibilities

The physician must:

Make every effort to clarify any exceptions to the above procedures

Ensure that the treatment team is aware of these situations and makes treatment decisions accordingly

Obtain prior instructions regarding resuscitation and potential medical emergencies

Life-sustaining treatment

Advance directives:
The treatment team must know the following regarding advance directives:

Whether the patient has a prior Advanced Directive

Has just initiated one

Prefers not to have one

Clinical staff responsibilities:
The social service worker, nurse and attending physician have and must follow the responsibilities described in detail in the "Advanced Directives" document.

Terminal patients:
Terminal patients are typically transferred to another facility.

Physician responsibilities toward terminal patients:
The attending physician is responsible for the following:

Must enact the advanced directive according to legislative guidelines

If he/she chooses not to follow the patient's advanced directive, must undertake specific alternative actions

Patient revocation:
The patient may revoke or re-execute an Advanced Directive at any time

Advanced directives information:
Additional details regarding Advanced Directives are found in the State of Texas Health and Safety Code, Chapter 166.

Consultation

Consultation with appropriate professionals at UTHCPC or in the UT-Houston Health Science Center is advised whenever uncertainty regarding clinical, ethical, or legal issues involved in these decisions exists.

Related standards

The Joint Commission : Provision of Care

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Harris County Psychiatric Center University of Texas Health Science Center