Hospitals weigh universal do-not-resuscitate orders for coronavirus patients

Hospitals across the country are considering whether to enact universal “do-not-resuscitate” orders for coronavirus patients as the mounting pandemic threatens to overwhelm the health care system, according to a report.

Northwestern Memorial Hospital in Chicago is among the hospitals where the drastic policy is under consideration — even when the move is against the wishes of a patient and their family, The Washington Post reported.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, told the outlet the hospital is exploring whether state law would allow it to implement the policy, which would limit possible exposure to health care workers and maximize resources.

“It’s a major concern for everyone,” Wunderink said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

These conversations come as hospitals face a surge in cases coupled with a shortage of life-saving ventilators and protective gear for staffers.

“We are now facing some difficult choices in how we apply medical resources — including staff,” Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, told the newspaper.

Having been through DNR, “do-not-resuscitate” decisions on both of my parents, it’s important to understand what resuscitation actually is. Resuscitation is when doctors, nurses, and other attendants, attempt to restore life to someone who has died. It can involve artificial respiration, chest compression, tracheotomies to insert breathing tubes, intubation in other ways, and more. There is generally no time to put on protective clothing, masks, and gloves. There can be significant bodily fluids in the room, and around the patient.

In my case, the first incident involved my mother when she was in her late 80s, and in the hospital for a gall bladder operation. I was surprised to see a DNR order on her chart when no one in the family had requested it. It was apparently routine for this to be ordered in circumstances such as my mother’s age. I asked that it be lifted, and it was. It never became necessary, either. At the time I didn’t fully appreciate the implications of what resuscitation really meant.

Later, both my mother and father became totally incapacitated from late stage dementia, and DNR orders were obviously appropriate and were allowed.

In this case, it must be recognized that most people who die from Covid-19, are quite aged and have complicating conditions. The decision to resuscitate should include considering risk to the attendants, the condition of the patient AFTER the resuscitation, and the likelihood of cognizant future living.

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