Question: I was told by a physician that a DNR becomes void with a suicide attempt. I was wondering how we should approach this situation.

 This is an interesting question and hopefully a rare clinical situation. Suicide specifically is not addressed in the MOHLTC Training Bulletin on the DNR Standard.

One of the first issues with this clinical scenario (DNR/Suicide patient) would have to be: who is it that activated 911? If there is a family member or other individuals who are present on scene demanding that CPR be initiated, then this is addressed by the MOHLTC training Bulleting on the DNR Standard.

In Section 1 A point #2 if the DNR Standard it states: A paramedic WILL initiate CPR on a patient who has experienced a respiratory or cardiorespiratory arrest when the substitute decision maker (SDM) has rescinded a valid DNR confirmation form by stating he/she wishes CPR to be performed or there is confusion as to who the SDM is and/or one or more people present at the time is demanding that CPR be initiated on the patient.

Link: http://www.lhsc.on.ca/About_Us/Base_Hospital_Program/No.108V.1.0DNRStandard.pdf

If there are no bystanders present on scene but somehow 911 was activated (perhaps by the patient themselves prior to self-harm) the other consideration would be to patch to the BHP for further direction in this rare situation.

DNR,Miscellaneous

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