Do not resuscitate orders in early intervention settings: Who should make the decision?

Suffer the Children

“…In general, however, parents have the right to raise children as they see fit unless abuse or neglect can be shown. In cases where a child's life is at stake, courts have sometimes overridden the parents' decision not to provide treatment (e.g., Jehovah's Witnesses v. King County Hospital and Wisconsin v. Yoder as cited in Brown & Valluzzi, 1995).…”

“…Originally it was intended to guarantee educational services at public expense to children with disabilities. However, over the years, it has been applied to children having special needs, including those who are medically fragile or technologically dependent (Brown & Valluzzi, 1995). The law has also been extended to apply to preschool programs for children aged 3 to 5 who have disabilities and to children from birth through age 2 who require intervention services because of developmental delay.…”

“…The extent of medical services and support that must be provided to seriously ill children is still unclear. In 1984, the U.S. Supreme Court ruled that "clean intermittent catheterization" was a procedure that schools could be required to provide for a special education student (Detsel v. Board of Education as cited in Brown & Valluzzi, 1995). Schools are also routinely expected to provide suctioning and medication administration.…”

“…Serious concerns are being raised concerning whether schools should be permitted to honor DNR orders and other types of advance directives. Under Washington state laws, teachers, educational staff members, and early intervention practitioners are not authorized to honor a DNR order; other states, however, have not explicitly addressed the situation, and school personnel often try to develop clear understanding of the family's wishes (including the child when possible) and honor these either through delay in securing emergency medical assistance or by trying to reach the parents and have them arrive on the scene in time to take charge of the DNR order (Brown & Valluzzi, 1995). It is clear, however, that schools and other organizations that are required to include ever sicker children will need to develop guidelines that can be tested by the courts and that these should be based on what is best for the child, his or her family, and the other children in the organization who may be affected.…”