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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.
"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.”
Any potential do-not-resuscitate policy would have to run in accordance with state laws.