For the first time, a family asked Lawrence school district officials to respect a do-not-resuscitate order for a student with a high-risk medical condition.
"I'm horrified that a parent would come to us," said Leni Salkind, a Lawrence school board member.
The issue has thrown the district into a tailspin because has no formal policy exists to guide staff on acceptance or rejection of these orders.
"It's a real interesting dilemma. It's a very touchy issue," said Doug Eicher, the district's executive director of special services.
The topic is under consideration by public school districts across the nation. Medical knowledge and technology have led to survival of many children who previously would have died of a variety of ailments. Consequently, children at a risk of dying while at school from chronic and terminal conditions is escalating.
"We have one request now and expect more," Eicher said.
In anticipation of additional requests, Eicher urged the school board Monday to endorse a policy that would authorize staff to defy do-not-resuscitate, or DNR, orders.
Under the proposal, the district would require staff to call 911 and provide emergency medical care, such as cardiopulmonary resuscitation. A child would be allowed to carry a do-not-resuscitate order, and that document would be given to paramedics upon arrival at a school, Eicher said.
However, the board was unwilling to set policy on this life-or-death issue without first studying legal, emotional and medical implications.
"There are so many unknowns," said Scott Morgan, a board member and an attorney. "We need to know what we're required to do and go into it will a full understanding."
In absence of a board policy, Supt. Randy Weseman said the district would reject do-not-resuscitate orders and respond with medical care.
In northeast Kansas, school boards responsible for the Tonganoxie, Leavenworth, Fort Leavenworth, Basehor-Linwood, Lansing and Easton districts have passed resolutions that mirror the proposal for Lawrence schools.
"The school personnel will do everything they can for the student while on school property," said Lynn Ahrens, director of a special-education cooperative serving 2,000 disabled students in the six districts.
Policy in those districts is to give DNR orders to paramedics.
Ahrens said decisions by school boards on this subject have significant implications for parents, but also for school staff and students.
For example, teachers who have invested much of themselves in the education of a student with muscular dystrophy, who could be at risk for sudden death attributable to arrhythmia, would be hard-pressed to turn away from that dying child. Another consideration is students in an ill child's classroom might observe a death, Ahrens said.
"A student might not understand why their classmate was allowed to die in front of them," Ahrens said. "We couldn't allow that to happen."
Eicher said the district's lawyer, Pete Curran, and legal counselors at the Kansas Association of School Boards advised the Lawrence district to establish a policy that rejected the orders.
But legal analysis in other states has raised red flags, Eicher said. In Massachusetts, the attorney general advised school districts to adhere to the orders. But Iowa's attorney general told districts not to comply.
"I feel very strongly that we not accept them," Eicher said.
Eicher said an alternative for families with terminally ill children was the district's homebound education program. Under that program, teachers deliver instruction in the home for children unable for medical reasons to attend classes at school.
Ahrens said the death of a student in a school building would be extremely rare.
"Parents do a good job of deciding when to stop the education of a student that is seriously ill," she said. "They come to school as long as they can, and that's best for the student. That's important for the classmates, the teachers, the student and the parents.
"But even if it's one child, we need to know what to do and how we would manage the situation."