Pre-hospital care and do not attempt to resuscitate orders: the legal and ethical consequences
The purpose of this dissertation is to provide clarity on the legal position of Do Not Attempt to Resuscitate (DNAR) orders for both patients and health care practitioners, especially emergency health care practitioners in the pre-hospital environment of South Africa. As there is no legislation governing DNAR orders in South Africa, emergency health care practitioners face uncertainty as to the medical treatment to be provided to a patient who has a DNAR order and is in cardiac arrest. Furthermore, emergency health care practitioners feel uncertain about the legal consequences for either adhering to the DNAR order or ignoring it. Very little research has been done to address the dilemma of DNAR orders in the pre-hospital environment and the legal effect thereof on emergency health care practitioners, especially in South Africa. A comparative study was done with the Unites States of America and the United Kingdom. The literature on research done in the USA and the UK provided clarity regarding the guidelines and legislation used in order to address DNAR orders as well as the possible legal and ethical dilemmas posed by the use of guidelines and legislation. This provided a possible solution for South Africa and with which known dilemmas can be addressed proactively instead of reactively. In conclusion, it was found that there is a need to allow the use of DNAR orders, which has to be regulated. Proposed legislation, focussing specifically on the pre-hospital environment and DNAR orders, is included in the study. It is furthermore suggested that proper guidelines should be developed from the proposed legislation, to be approved by the Minister of Health, in order to provide clarity for health care practitioners, on the use and enforcement of DNAR orders.