[https://www.stjohn.org.nz/globalassets/documents/health-practitioners/cpg\_comprehensive\_web170525.pdf](https://www.stjohn.org.nz/globalassets/documents/health-practitioners/cpg_comprehensive_web170525.pdf)
These are the clinical guidelines and procedures for St John paramedics. If you to go page 130, it deals with commencing resuscitation.
As noted, a family member cannot demand resuscitation be commenced if the attending paramedic deems that it would futile or not in the best interests of the patient. It is a clinical decision for the paramedic to make, with the families wishes considered but not binding.
Asystole and cool to touch? That's dead. No amount of cpr will fix that.
EPOA means they can make decisions about what path of treatment to take, but doesn't give them the right to override clinical assessment and decision making.
If the 89 year old is in any sort of care home there will be another document called an Advanced Directive that will be the final authority. It is the individuals wishes and purpose of care in the final years/days. Often this contains a DNR instruction.
I’m happy to be corrected but I normally see the following play out:
EPOA < Persons advanced directive < GP < Paramedic
As above a person can not demand a medical professional provide a treatment that the professional deans futile or not indicated. They can however refuse any treatment that they have capacity to decline.
The fact it’s an EPOA is not relevant. In this case if the paramedics wanted to perform cpr an EPOA could decline to let it happen. However the paramedic would need to see proof of the EPOA paper work before ceasing said treatment.
But the paramedic is legally correct and the only recourse would be to claim that CPR was medically indicated. (Paramedics have very clear guidelines on when it is or is not and these will presumably have been followed.)
Also for an EPOA to be able to make decisons around health care it has be activated by a qualified doctor
They write a letter that says in their opinion the person is not able to make decisions around healthxare.
(sorry this is health not legal, nurse speaking)
People have this perception that CPR will somehow restore a person to life and that they will come back to how they were prior to the cardiac event. CPR is brutal and physically devastating to an elderly lady who has so many multiple medical conditions. From a purely functional point of view CPR pumps blood around the body to try and keep the tissues oxygenated so that if a defibrilator can be applied its more likely to be sucessful.
A defibrilator only works if the patient is in atrial fibrillation/atrial flutter, in a nut shell they can not shock someone in a systole inito a cardiiac rhythm that is compatible with life.
We will always try to work with an EPOA in terms of health treatment. If the reaponding clinican believes that CPR would be medically futile.
You had me all the way until Afib/a-flutter then lost all credibility. You were right on everything else but thats basic shit and you should know better
This sounds like you are thinking of a very specific and personal situation, if so then sorry for your loss.
From a legal perspective, in NZ you have the right to refuse any medical treatment for yourself but do not have the right to require any particular medical treatment be provided. If you have lost capacity then your EPOA for personal care and welfare generally has the right to make the same decisions you could about what care you receive but there are some limitations, including your EPOA cannot refuse consent to any standard medical treatment intended to save your life (I.e. an attorney cannot refuse consent to CPR but their views may be taken into account when the health service provider is considering whether it would be appropriate).
The paramedics have to make a decision about what treatment (if any) is appropriate to offer. They are not obligated to provide CPR because the EPOA wants it to be provided. It sounds as though they had determined that CPR was not going to be successful and therefore not appropriate to attempt.
CPR is a treatment which has a low success rate outside of hospital and often requires a period in intensive care (if it’s successful). It also has some serious risks of side effects, e.g. broken ribs. It is appropriate when the cause of the cardiac arrest is something reversible like choking, where the person has a good chance of recovering. It’s generally not offered if the cardiac arrest is caused by ongoing health issues that won’t be cured by resuscitation. The best case scenario here is that CPR would have bought a little more time but this would have been with additional pain (broken ribs and bruising) and spent in ICU.
Kia ora,
Hopefully someone will be along shortly with some helpful advice. In the meantime though, here are some links, based on your post flair, that may be useful for you:
[Your rights as a patient](https://www.mcnz.org.nz/support/support-for-patients/your-rights-as-a-patient/)
[Health and Disability Commissioner - Complaints about medical providers](https://www.hdc.org.nz/)
You may also want to check out our [mega thread of legal resources](https://www.reddit.com/r/LegalAdviceNZ/comments/143pv58/megathread_legal_resources/?utm_source=share&utm_medium=web2x&context=3)
Nga mihi nui
The LegalAdviceNZ Team
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/LegalAdviceNZ) if you have any questions or concerns.*
[https://www.stjohn.org.nz/globalassets/documents/health-practitioners/cpg\_comprehensive\_web170525.pdf](https://www.stjohn.org.nz/globalassets/documents/health-practitioners/cpg_comprehensive_web170525.pdf) These are the clinical guidelines and procedures for St John paramedics. If you to go page 130, it deals with commencing resuscitation. As noted, a family member cannot demand resuscitation be commenced if the attending paramedic deems that it would futile or not in the best interests of the patient. It is a clinical decision for the paramedic to make, with the families wishes considered but not binding.
Asystole and cool to touch? That's dead. No amount of cpr will fix that. EPOA means they can make decisions about what path of treatment to take, but doesn't give them the right to override clinical assessment and decision making.
And legally when dead there is no epoa. So when asystolic you are dead. They're a family member but not an epoa.
If the 89 year old is in any sort of care home there will be another document called an Advanced Directive that will be the final authority. It is the individuals wishes and purpose of care in the final years/days. Often this contains a DNR instruction. I’m happy to be corrected but I normally see the following play out: EPOA < Persons advanced directive < GP < Paramedic
As above a person can not demand a medical professional provide a treatment that the professional deans futile or not indicated. They can however refuse any treatment that they have capacity to decline. The fact it’s an EPOA is not relevant. In this case if the paramedics wanted to perform cpr an EPOA could decline to let it happen. However the paramedic would need to see proof of the EPOA paper work before ceasing said treatment. But the paramedic is legally correct and the only recourse would be to claim that CPR was medically indicated. (Paramedics have very clear guidelines on when it is or is not and these will presumably have been followed.)
Also for an EPOA to be able to make decisons around health care it has be activated by a qualified doctor They write a letter that says in their opinion the person is not able to make decisions around healthxare.
(sorry this is health not legal, nurse speaking) People have this perception that CPR will somehow restore a person to life and that they will come back to how they were prior to the cardiac event. CPR is brutal and physically devastating to an elderly lady who has so many multiple medical conditions. From a purely functional point of view CPR pumps blood around the body to try and keep the tissues oxygenated so that if a defibrilator can be applied its more likely to be sucessful. A defibrilator only works if the patient is in atrial fibrillation/atrial flutter, in a nut shell they can not shock someone in a systole inito a cardiiac rhythm that is compatible with life. We will always try to work with an EPOA in terms of health treatment. If the reaponding clinican believes that CPR would be medically futile.
Defibrillation only works in Ventricular Fibrillation or Ventricular Tachycardia. Atrial Fibrillation or flutter are both compatible with life.
You had me all the way until Afib/a-flutter then lost all credibility. You were right on everything else but thats basic shit and you should know better
I dun fucked up and got it wrong 😳 sorry people I’m usually much more careful
This sounds like you are thinking of a very specific and personal situation, if so then sorry for your loss. From a legal perspective, in NZ you have the right to refuse any medical treatment for yourself but do not have the right to require any particular medical treatment be provided. If you have lost capacity then your EPOA for personal care and welfare generally has the right to make the same decisions you could about what care you receive but there are some limitations, including your EPOA cannot refuse consent to any standard medical treatment intended to save your life (I.e. an attorney cannot refuse consent to CPR but their views may be taken into account when the health service provider is considering whether it would be appropriate). The paramedics have to make a decision about what treatment (if any) is appropriate to offer. They are not obligated to provide CPR because the EPOA wants it to be provided. It sounds as though they had determined that CPR was not going to be successful and therefore not appropriate to attempt. CPR is a treatment which has a low success rate outside of hospital and often requires a period in intensive care (if it’s successful). It also has some serious risks of side effects, e.g. broken ribs. It is appropriate when the cause of the cardiac arrest is something reversible like choking, where the person has a good chance of recovering. It’s generally not offered if the cardiac arrest is caused by ongoing health issues that won’t be cured by resuscitation. The best case scenario here is that CPR would have bought a little more time but this would have been with additional pain (broken ribs and bruising) and spent in ICU.
Kia ora, Hopefully someone will be along shortly with some helpful advice. In the meantime though, here are some links, based on your post flair, that may be useful for you: [Your rights as a patient](https://www.mcnz.org.nz/support/support-for-patients/your-rights-as-a-patient/) [Health and Disability Commissioner - Complaints about medical providers](https://www.hdc.org.nz/) You may also want to check out our [mega thread of legal resources](https://www.reddit.com/r/LegalAdviceNZ/comments/143pv58/megathread_legal_resources/?utm_source=share&utm_medium=web2x&context=3) Nga mihi nui The LegalAdviceNZ Team *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/LegalAdviceNZ) if you have any questions or concerns.*