TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

IN OPPOSITION TO

L.D. 125, AN ACT TO ALLOW AN ORDER NOT TO RESUSCITATE TO BE PRESENTED IN THE FORM OF AN INDELIBLE MARK

Joint Standing Committee on Judiciary

Room 438, State House

Thursday, February 9, 2017, 1:00 p.m.

Good afternoon Senator Keim, Representative Moonen, and Members of the Joint Standing Committee on Judiciary.  My name is Andrew MacLean and I am Deputy Executive Vice President & General Counsel of the Maine Medical Association and I am speaking in opposition to L.D. 125, An Act to Allow an Order Not to Resuscitate to be Presented in the Form of an Indelible Mark.

The Maine Medical Association is a professional organization representing more than 4000 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The MMA and the Maine Chapter of the American College of Emergency Physicians have substantial concern about this proposal to change the Maine Emergency Medical Services protocol in reaction to what I assume is one constituent’s specific situation.  EMS personnel must react very quickly in the field and, in order to recognize, interpret, and properly respond to a do-not-resuscitate or DNR order, it must be in a format that is commonly recognized among EMS personnel, such as a MedicAlert bracelet or the standard form included as Part 7 (pages 13 and 14) of the model Maine Health Care Advance Directive Form (attached).  A MedicAlert bracelet is found and easily recognized on an individual’s wrist.  When we speak to patient groups about the model DNR form in Part 7, we suggest that it should be displayed in a prominent place in the home, such as the front of the refrigerator and it is even better if it is printed on bright orange paper.  EMS personnel can recognize and act in accordance with the DNR order in formats such as these two.  In contrast, a tattoo could be anywhere on the body and could be obscured by clothing.  Moreover, it could be very difficult for EMS personnel to determine the validity of a tattoo representation of a DNR order because it may not include dates of signature or expiration, and may not have any indication that the patient has been counseled by his or her physician about the implications of a DNR order.  How would EMS personnel know if the patient had revoked a tattoo representation of a DNR order?

As additional background, I have attached Opinion 5.4, Orders Not to Attempt Resuscitation (DNAR) from the Code of Medical Ethics of the American Medical Association.

For the reasons mentioned above, we believe it would be unwise to proceed with L.D. 125.

Thank you for considering the views of the Maine Medical Association and the Maine Chapter of the American College of Emergency Physicians on L.D. 125.  I would be happy to respond to any questions you may have.