The utter devastation of the realization that your child will predecease you is nearly unimaginable. The decisions that we force upon parents in this situation can compound their grief and distress...

*The views expressed in this paper are those of the author and do not necessarily represent those of the American Medical Association.

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, (...) regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored. (shrink)

Caring for children with life-shortening illnesses is a humbling task. While some decisions are simple and safe, the emotionally-charged choices regarding how to best care for these children often...