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Asante updates Code Status Designation policy

Revised policy clarifies what to do if a patient with a DNR attempts suicide in the hospital.


The Asante Code Status Designation policy was recently updated during its triannual review. The update adds clarification on how staff respond to a cardiopulmonary arrest when an Asante patient has a Do Not Resuscitate or Do Not Intubate order and it appears the patient may have been attempting to commit suicide while hospitalized.

The new policy wording was a collaborative effort by the Asante System Bioethics Committee, or ASBEC. This is a multidisciplinary group that includes practicing physicians, nurses, pastoral care, Asante’s legal team and Risk Management leaders along with retired health care professionals and lay community members. The new paragraph reads:

Exception to following a DNR or DNI order: Health care professionals attempt to rescue/revive individuals who attempt suicide, regardless of their documented code status. If an Asante patient experiences cardiopulmonary arrest due to a suspected or confirmed suicide attempt, a full code is initiated, even if they have documented DNR/DNI status. For ongoing care, the physician code leader will assess the benefit of continuing resuscitative efforts versus moving to comfort care based on the patient’s clinical history, prior health status, prior health care directives and input from a legally appointed health proxy, if available, taking considerations from Paragraph 5 below into account to determine further medical decisions.

Paragraph 5 is unchanged:

Neither the hospital nor providers are obligated to initiate or continue medically useless resuscitation. When death is imminent for a terminally ill patient, any treatment, including resuscitation, which cannot reasonably be expected to be efficacious can be omitted. When resuscitation, based upon reasonable medical certainty, would be of no benefit, CPR and resuscitative efforts may be stopped. Medically useless treatment does not preclude medication or interventions that are provided for the patient’s care or comfort.

The rationale behind the policy addition is that when patients come to an Asante hospital, they expect to be cared for in an environment where they will be safe. Those who are at risk for self-harm (whether we are fully aware of their risk or not) are kept safe from self-harm as much as is possible while under our care.

The policy also now outlines how those who are following Oregon’s Death with Dignity Act are cared for in accordance with the law should they arrive at the hospital after an unsuccessful attempt to end their life.

More information on Asante’s policy on the Death with Dignity Act can be found on myAsanteNET. The Asante System Bio-Ethics Committee can be reached when ethical questions arise by emailing [email protected].

What is the Asante System Bioethics Committee?

The committee exists to serve the Asante health system and the counties of Jackson and Josephine with questions regarding medical ethics, compassionate care and institutional integrity.

The committee meets monthly, or more often if needed, and is composed of hospital physicians, nurses and administration, in addition to representatives from the Legal and Spiritual Care teams, social workers and the public.

We welcome questions from providers and also from patients and their representatives.

Frequent topics of discussion include cases in which care might be futile, when patients cannot make their own decisions and lack a surrogate, or when team members are concerned that a treatment plan or policy is not consistent with patients’ best interests or expressed wishes.

When needed, we also assist with policy formation to ensure that the actions of the entire Asante team and institution are fair, equitable, honest and, above all, compassionate.

Anyone requesting a consultation may email [email protected]

—Douglas Hecox, MD
Nephrologist, Renal Care Consultants

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