Title: The Conundrum of Overlooking DNRs: Charting Patient Rights and Liability in Medical Crises

Within a complicated terrain of moral duties and legal ambiguities, the trend of overlooking Do Not Resuscitate (DNR) orders, especially concerning terminally ill individuals, prompts significant ethical dilemmas. The clash between patient moral decisions and liability fears frequently results in healthcare professionals or other stakeholders overriding these directives, which can lead to serious legal and personal ramifications.

As noted in a Journal of Air Law and Commerce piece, the apprehension of litigation arising from “wrongful life” lawsuits creates conditions where medical personnel might opt to resuscitate a patient with a legitimate DNR, thus infringing upon their autonomy and recognized patient rights. In 2024, a presentation entitled “You’re suing me because I kept your mom alive? Avoiding wrongful life lawsuits” highlighted the consequences faced by healthcare workers who ignore DNRs, spotlighting the legal disputes emerging nationwide against doctors who bypass such orders.

A prominent case that emerged involved an inquiry from the proprietor of Flying Angels, a non-emergency medical transport service, about the compliance with DNRs during flights. It was disclosed that flight crew protocols typically involve ignoring DNRs in favor of attempts at resuscitation, pointing to a significant void in legal authority regarding medical emergencies that occur mid-flight. Neither federal regulations nor precedents definitively clarify whether airlines ought to respect or disregard DNRs in in-flight medical situations.

Flight crews often default to attempting to resuscitate passengers regardless of any existing DNRs due to various factors, including legal uncertainties, aviation laws, safety issues, and divergent state-specific regulations. The Centers for Disease Control’s (CDC) Yellow Book recognizes these inconsistencies, advising travelers with a DNR to be aware of the possibility that airlines may uphold policies requiring resuscitation efforts. For instance, Hawaiian Airlines explicitly states in their contract of carriage that DNRs are not honored, indicating passenger consent to treatment simply by choosing to fly with them.

The ethical intricacies of such policies, often concealed within the complex legal language of travel agreements, raise concerns about transparency and the rights of individuals to decline medical interventions. Public sentiment, as shown in platforms like Flyer Talk, largely rejects these practices, advocating for increased respect for personal medical choices during flights.

From the viewpoint of pilots, this issue also brings forth a moral quandary. A retired airline captain articulated that, despite protocol, he would abstain from performing CPR if presented with documentation or verbal assurance of a patient’s medical power of attorney, prioritizing moral accountability over legal mandates.

Such dilemmas are particularly relevant for organizations like the Honor Flight Network (HFN), which orchestrates journeys for veterans, many of whom are elderly or terminally ill. The inconsistency in acknowledging DNRs across various hubs and state boundaries complicates the guarantee that a veteran’s end-of-life preferences will be honored during flights.

The absence of consistent rules for medical emergencies on flights underscores the urgent need for reform. Advocates for universal guidelines stress the importance of clear legal and ethical responsibilities regarding onboard medical responses. Establishing standardized in-flight medical emergency protocols and safeguarding the right to refuse treatment could enhance patient autonomy and align practices with accepted healthcare norms.

Travelers might enhance the probability that their DNR is respected by carrying accessible documentation and ensuring that their companions are informed advocates. Nonetheless, systemic advancements at the industry level, potentially initiated by legal challenges or legislative efforts, will be vital for consistently upholding patient rights.

In the end, airlines possess the ability to adapt their protocols in ways that honor validated DNRs, finding a balance between ethical standards and operational as well as legal considerations. Involvement from healthcare advocacy organizations could further advance this objective, pushing for policy changes that more effectively honor the autonomy and desires of individuals, even at 30,000 feet in the air.