Triage Getting Real - Hospitals Making Your DNR Decision for You
Hospitals weigh blanket DNR orders for coronavirus patients amid equipment shortages: report
By Brie Stimson
Published March 26, 2020
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As hospitals across the country face shortages of personal protective equipment due to surges of coronavirus patients, health care professionals are reportedly privately discussing the possibility of a blanket do-not-resuscitate policy for infected patients to mitigate the risks for those responding to a code blue.
“If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” bioethicist Scott Halpern at the University of Pennsylvania wrote in a circulated model guideline, according to The Washington Post. Still, he said a blanket do-not-resuscitate policy for all COVID-19 patients is too ”draconian.”
He suggested the patient’s doctor and another should sign off on case-by-case do-not-resuscitate orders for coronavirus patients, giving the reason to the family – although they don’t have to agree with it.
Richard Wunderink, an intensive-care medical director at Northwestern, said that many families are choosing to sign DNRs when hospital staff explain that having to put on protective gear before tending to a "coding" patient decreases the chance of saving their life.
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"By the time you get all gowned up and double-gloved the patient is going to be dead,” Fred Wyese, an ICU nurse in Michigan, told The Post. “We are going to be coding dead people. It is a nightmare.”
Doctors swear an oath to do everything they can to save a patient’s life, but as COVID-19 cases surge, shortages in necessary PPE are forcing medical professionals into ethical quandaries.
"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, said, according to The Post.
When a patient “codes,” meaning they’ve gone into cardiac arrest, all available staff respond to the code blue to perform CPR and other lifesaving measures.
“It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” R. Alta Charo, a University of Wisconsin-Madison bioethicist, said. “The code process is one that puts them at an enhanced risk.”
Often dozens of masks, gowns and gloves can be used in the process.
“It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,” an unidentified ICU doctor told The Post.
At George Washington University, they use a machine to perform compressions on a coding patient, but since there are only two available, as a contingency hospital staff will place plastic sheeting over the patient as a barrier before beginning CPR.
“From a safety perspective you can make the argument that the safest thing is to do nothing,” Bruno Petinaux, chief medical officer at GW told The Post. “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.”
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Any potential do-not-resuscitate policy would have to run in accordance with state laws.
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I get the rationale.........but it is still a shame that we have come to this. Next step could feasibly be the feared "death panels" that just turn away certain segments of the population (i.e. 70+) 0 -
I has been done every day in hospitals across this country as it should be. While it sounds evil when one says that now doctors are making DNR decisions for you, it is a part of their occupation. People can be put on heart/lung equipment and maintained indefinitely, but if something is demonstrably not survivable, the patient should be kept as comfortable as possible and allowed to die.
It is just stupid to respond to a code of someone who is dying of congestive heart failure (as an example) simply because a virus is accelerating the process.0 -
"Triage" is a term mis-used by the med-pros. It is a military term, apropos to a an after-action assessment of dead, near-dead, wounded, and walking wounded. The first time I heard that term used was by a bright-eyed idiot in my Red Cross First Aid/CPR/EMT class that was a part of my basic police training in Arkansas. Idiot was very enthusiastic, looking forward to the opportunity to play God, and deciding who lives and who dies. The instructor shut him down quick, remonstrated him for his God-complex attitude, explained the PROPER use of the term, reiterated that it has NO place in any sort of civilian medical practice, and forbade its use for the remainder of the course.
There are still med-pros out there, salivating at the opportunity to play God. I have had a few unpleasant conversations with some of them on Facebook, that didn't go well. The older I get, the less "life in prison" is a deterrent.3 -
Don and Nunn: well-considered points, as always. Thanks.
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Trying to lighten up a very serious subject here. All good points made.
Now in some parts of the country, a triage is just a homemade corsage for the prom date. Since there were no flowers available, some tree leaves and pine branches were used.
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Somewhat tongue in cheek this speaks to potentially contracting the illness on purpose in areas not yet over loaded so you can get it over with and have plenty of resources still to treat you. 0
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