Hospitals Face Possibility of Instituting Do-Not-Resuscitate Orders for Patients Infected With Coronavirus

Illustration for article titled Hospitals Face Possibility of Instituting Do-Not-Resuscitate Orders for Patients Infected With Coronavirus

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At this point, it should be no secret that the U.S. wasn’t ready to deal with a global pandemic. Between nationwide shortfalls in testing for the coronavirus to a shortage of medical supplies, it has been a mess.

Now, these issues are causing medical professionals to consider one of the hardest, most heartbreaking things they’ve likely ever had to consider: whether or not it’s worth it to keep everyone alive.

The Washington Post reports that across the country, hospital staffs are engaged in private discussions about what the policy should be regarding resuscitating patients who are dying as shortages of protective equipment like gloves and surgical masks leave doctors and nurses in danger of exposing themselves to infection while in the process of doing their jobs.

At Chicago’s Northwestern Memorial Hospital, for example, there has been discussion about the possibility of instituting a do-not-resuscitate policy for infected patients that would be enacted regardless of the wishes of the patient or their family.

“It’s a major concern for everyone,” intensive-care medical director at Northwestern Richard Wunderink told the Post. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

To be clear, healthcare providers are bound by oath to do everything they can to save a patient’s life unless there is a do not resuscitate (DNR) order in place. The idea of medical professionals seeking a way to get around that obligation may seem cold at first glance, but these are not normal times; this is a crisis.

What has to be considered is that when a patient “codes” (goes into cardiopulmonary arrest), anywhere from around eight to as many as 30 doctors and nurses have to rush into a hospital room to begin emergency procedures. This means a lot of people, a lot of bodily fluids and, often, a chaotic frenzy are involved.

From the Post:

Fred Wyese, an ICU nurse in Muskegon, Mich., describes it like a storm:

A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a “crash cart” stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.

As soon as possible, a breathing tube will be placed down the throat and the person will be hooked up to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there’s often no clear cut answer for when there’s still hope and when it’s too late.

Protective equipment is used in the process — often many dozens of gloves, gowns, masks, and more.

So what should hospital staff do under these conditions? Do they do their jobs and make their best attempt at saving the patient’s life and risk going from one infected person to possibly dozens, or do they make what many would consider a much harder decision?

“From a safety perspective you can make the argument that the safest thing is to do nothing,” chief medical officer at George Washington University Hospital Bruno Petinaux said. “I don’t believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely.”

It’s hard to imagine that any healthcare provider wants to let patients die. The very discussion of instituting do-not-resuscitate policies even in cases where that isn’t what the patient or their families want is likely a nightmare they never thought they’d have to deal with in their career. But this is where we are, and it is terrifying.

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