One decision. One judgement call. One reaction.
In EMS, unlike most businesses, just one choice among many possible choices in the middle of an incredibly difficult situation can cost you everything. Such may be the case for a rescue crew in Maplewood, Minn., after granting the wishes of a grieving husband to let his wife go; to allow an end to her suffering.
The story was widely reported after a nursing home patient was allegedly found in cardiac arrest. The patient had been battling Parkinson’s disease for two decades and had deteriorated to a near vegetative state when paramedics were called because she had stopped breathing and nursing home staff had initiated CPR.
According to news reports, medics intubated and were able to regain pulses when her husband of 50 years asked them to stop; he explained that she did not want to be kept alive by machines and that it was time for her suffering to end – that it was her wish not to be resuscitated. The medics complied and wheeled her into a room in the nursing home where she died some 20 minutes later. The family is able to grieve and she is at peace.
Punishing compassion
Of course, their acquiescence and compassion did not go unpunished. Because there was no written advance directive nor was there a DNR, the local sheriff’s office had no alternative, but to initiate a criminal investigation. Thankfully (and rightly), the sheriff found no criminal conduct and no charges will be filed.
Despite the absence of criminal conduct and despite the fact that nobody has complained about the decision the providers made, all six responders were placed on administrative leave by the city, where an investigation is ongoing and discipline could be forthcoming.
Lawfulness and righteousness
Unfortunately, the law and righteousness don’t always coincide. I cannot think of anyone I know – myself included – who would not have wanted to do exactly what this crew did; allow this woman’s suffering to end at the request of the loving husband who knew her better than anyone else in the world and but for the absence of a silly piece of paper, there would have been no issue.
The law, on the other hand, intends to take the guess work out of otherwise emotionally difficult situations. It intends to reduce decision-making to black and white: there is a signed order or there isn’t and if there isn’t, then providers are bound by policy, protocol, and procedure to employ full resuscitation efforts and transport. Save your angry emails; I don’t like it any more than you do.
Great exposure with little protection
This case is a prime example of how EMS providers accept the greatest amount of exposure with the least amount of protection. All too often, providers are caught between a rock and another rock because doing what’s right may not be legal and doing what’s legal isn’t always right.
However, the law is clear. There are courts of law; there are no courts of righteousness, so, when in doubt, policy, protocol, and procedure must win out or the system collapses. Then again, blindly following protocols is for robots.
There is an answer to this conundrum.
Policy must evolve and paramedics must be allowed to employ the discretion for which they have worked so hard. Paramedics must be afforded the right and opportunity to exercise a degree of autonomy in situations where the law and righteousness don’t always agree. Properly trained and educated paramedics must be allowed to be human in situations that call for the highest degree of humanity; situations where the black and white of the law fade to gray.
Naturally, doing so would add to an already overwhelming degree of responsibility and liability, but that’s what happens when you want to play in the big leagues.
Professionalization of paramedics
Policy changes toward such discretion and autonomy must be preceded by proof that the field is prepared to make righteous decisions in good faith and not from a place of complacency or malaise. In my experience, and yours too I’m sure, such is not always the case and that may be the greatest obstacle for the complete professionalization of paramedics – and the subject of another column.
While policy may not agree with what this crew did, I do. I sincerely hope that the city will also find that acting in good faith – as was the case here – should not be punished, but applauded even when it makes us uncomfortable. I hope the powers that be in Maplewood, Minn., will see that no good can possibly come from imposing discipline on these responders and that this is a teachable moment for us all.
Finally, as a lawyer, my advice is always to follow policy, protocol, and procedure. As an EMS provider, however, I respect what this crew did and I hope it will lead to positive changes in the way situations like this can be managed in the future.
