POLICIES OF REGIONAL HEALTH AUTHORITIES (RHA’s) AND HOSPITALS IN MANITOBA

Each of the Regional Health Authorities in Manitoba and a sampling of 26 rural and urban hospitals and long-term care facilities throughout the province where approached during this research project and requested to provide information regarding the policies these authorities and institutions hold concerning DNR Orders.

The specific questions directed to them were the following:

1.	What are the current DNR Order placement protocols for your RHA catchment area and/or hospital or care facility?
2.	Is it mandatory that the patient or patient advocate/surrogate have knowledge of the placement of a DNR Order?
3.	Is it mandatory that the patient or patient advocate/surrogate give consent to the placement of a DNR Order?
4.	Does your RHA catchment area/hospital/care facility have an ethics board or similar body which is consulted in decision-making regarding DNR Orders?
5.	If such an ethics board exists, is there any community representation on that board?
6.	What protocols exist for DNR Order placement when a doctor and a patient or patient advocate/surrogate disagree about that placement?
7.	Would your organization support the idea of having persons with disabilities involved in establishing guidelines regarding DNR Orders in medical facilities? If so, how would that involvement occur?

Responses to these questions are recorded are as follows:

REGIONAL HEALTH AUTHORITIES

1.	Re: Current DNR Order Policies
		one region stated the patient had the final say in determining DNR Order placement
		one region stated their DNR policy was based on a prior Advance Health Care Directive or determined by the physician in consultation with patient or patient proxy
		one region stated competent patients had the final say
		one region had no policy
		the remainder of regions reported they had policy development underway.
2.	Re: Patient/Proxy Knowledge of DNR Order Placement
		3 regions reported that patient/proxy knowledge is mandatory
		1 region reported that the practice of informing patients/proxies of DNR Order placement is encouraged
		1 region reported that patient/proxy knowledge is not required, and that the decision to inform them is made by individual facilities within the region
		the remainder reported that policy development is underway
3.	Re: Patient/Proxy Consent of DNR Order Placement
		3 regions reported that patient/proxy consent is mandatory
		1 region reported that the practice of obtaining consent from patients/proxies of DNR Order placement is encouraged
		1 region reported that patient/proxy consent is not required, and that the decision to inform them is made by individual facilities within the RHA
		the remainder reported that policy development is underway
4.	Re: the Existence of an Ethics Board or Similar Body Consulted on Ethical Issues
		3 regions reported they had no ethics board or similar body
		2 regions reported they had an ethics board
		1 region reported they had no ethics board but consulted with the Health Sciences Centre ethics committee as required
		the remainder reported that development of this concept was underway
5.	Re: Community Representation on the Ethics Board
		2 regions reported that they had community representation on their Ethics Board
		2 regions reported they had no community representation on their Ethics Board
		1 region reported that this information was not available
		1 region reported that community representation on an ethics board was not applicable to an RHA
6.	Re: Policies Concerning a Disagreement Between a Patient/Proxy and a Physician Regarding a DNR Order Placement
		1 region reported that a 2nd consult can be requested, but that the patient/proxy has the final say
		1 region reported that the patient/proxy has the final say
		1 region reported that a competent patient has the final say
		the remainder of the regions had no policies in place, 1 of these stated that this policy was in development
7.	Re: Representation of Persons with Disabilities in Establishing Guidelines Concerning DNR Order Placement
		1 region reported that they had identified people in the community to provide feedback regarding DNR Order policies
		the remained of the regions did not have any representation of persons with disabilities in establishing guidelines. Out of this group, 1 reported that there was support for the idea of input through focus groups or committee representation, and 1 was open to input from the Manitoba League of Persons with Disabilities.

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