• Kyodo

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Ambulance crews have recently found themselves up against the serious issue of how to respond to cases in which family members of patients suffering cardiac arrest refuse CPR, claiming that the patients do not wish to receive such treatment.

On Wednesday, the Fire and Disaster Management Agency approved a report by an expert panel that concluded it was difficult to come up with a policy, despite fire departments in various areas having asked for guidelines.

Such cases are often seen when elderly or terminally ill patients who have asked to die at home, or have left a DNR (do-not-resuscitate) order, suffer cardiac arrest and someone unaware of the patient’s wishes calls an ambulance. The ambulance crew then encounter a refusal to receive treatment after they have arrived.

According to the agency’s survey, out of 728 fire departments nationwide as many as 403 have said they have experienced such cases.

“This is a problem unique to the superaging society, and rescue crew members are at a loss on what to do,” said Norio Higuchi, a professor of medical ethics at Musashino University who heads the panel.

But the panel’s report points out that only a limited number of fire departments keep records of such cases, and that it is necessary first to collect more data, and take into consideration both public opinion and typical scenarios in terminal care, before creating a guideline.

Meanwhile, the agency’s survey says 332 fire departments have their own rules on what to do when their assistance is rejected.

The Osaka Municipal Fire Department decided in 2015 to attempt resuscitation regardless of the family’s wishes, and to send them to the hospital unless it is completely clear that a patient is dead. This is partly out of fear that giving up resuscitation would be a violation of the Fire Service Law, since there are no unified rules on such cases.

Department officials say, however, that they are sometimes criticized when conducting resuscitation on the patients, especially in situations when patients become brain-dead as a result.

On the other hand, the Saitamaseibu Fire Bureau in Saitama Prefecture set a specific rule in 2017 saying that rescue crews can cancel a resuscitation attempt if they obtain a letter of consent from the patient’s family and instruction from a doctor. The bureau said the rule was made as there was a compelling need for crews called to attend medical incidents.

The Tokyo Fire Department plans to create a new rule by the end of this year to allow ambulance crews to cancel resuscitation attempts for terminally-ill patients who have told their doctors they don’t want to receive such treatment if their heart stops.

“How a person ends his or her life is an ethical issue and goes beyond the scope of rescue workers’ tasks,” an agency official said.

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