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Doctors deciding whether to enact do-not-resuscitate orders for coronavirus patients

Doctors across the country are deciding whether to adopt standard policies for not resuscitating patients with coronavirus in an effort to curb possible virus exposure for medical staff. 

In Chicago, the Northwestern Memorial Hospital has been debating how to implement a universal do-not-resuscitate policy for infected patients. 

The policy would void the wishes of the patient or their family members. 

The death toll for Covid-19 in the United States has risen to 823 with more than 60,000 confirmed cases, and the burden of the pandemic continues to intensify in hospitals across the country.

Doctors across the country are deciding whether to adopt standard policies for not resuscitating patients with coronavirus. A nurse is seen emerging from a tent with a coronavirus testing kit at a drive thru testing station in Seattle, Washington on March 16

Doctors across the country are deciding whether to adopt standard policies for not resuscitating patients with coronavirus. A nurse is seen emerging from a tent with a coronavirus testing kit at a drive thru testing station in Seattle, Washington on March 16

The death toll for COVID-19 in the United States has risen to 823 with more than 60,000 confirmed cases

The death toll for COVID-19 in the United States has risen to 823 with more than 60,000 confirmed cases

Richard Wunderink, an intensive-care medical director at the Chicago hospital, said administrators have asked Illinois Governor J.B. Pritzker for assistance in clarifying how state law would permit a policy shift. 

‘It’s a major concern for everyone,’ he explained to the Washington 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.’

Wunderink did describe patient health as a steady decline rather than a sudden drop, giving medical personnel time to discuss plans with family members.

Similar discussions around not resuscitating have been taking place at the George Washington University Hospital in D.C. 

They’ve decided, however, to continue using modified procedures to resuscitate patients with coronavirus – including putting plastic sheeting over patients to create a barrier. 

Richard Wunderink, an intensive-care medical director at the Chicago hospital, said administrators have asked Illinois Governor J.B. Pritzker for assistance in clarifying how state law would permit a policy shift

Richard Wunderink, an intensive-care medical director at the Chicago hospital, said administrators have asked Illinois Governor J.B. Pritzker for assistance in clarifying how state law would permit a policy shift

At the University of Washington Medical Center in Seattle, the number of responders sent to contagious patients in cardiac or respiratory arrest has been limited. 

Atrium Health in the Carolinas, Geisinger in Pennsylvania and the Kaiser Permanente networks are just some of the large hospital systems across the country that are determining whether to override the wishes of coronavirus patients or their families on a case-by-case basis. These hospitals won’t take the ultimate step of sanctioning all coronavirus patients to the do-not-resuscitate order.

'We are now on crisis footing,' said Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon. 'What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff'

‘We are now on crisis footing,’ said Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon. ‘What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff’

‘We are now on crisis footing,’ said Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon. ‘What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.’  

For Alta Charo, a bioethicist with the University of Wisconsin – Madison, withholding treatments is a very pragmatic decision. 

‘It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,’ she said. ‘The code process is one that puts them at an enhanced risk.’

While doctors are bound by the Hippocratic Oath to put forth their best effort to save patients lives, they are put in increasingly stressful situations as the coronavirus pandemic depletes resources and staff face exposure to the virus.

When a ‘code blue’ alarm sounds, medical personnel are notified that a patient has gone into cardiopulmonary arrest – signaling for eight to 30 people to rush in to perform life saving measures.

‘It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,’ said an anonymous medical person from the Midwest.    

Bioethicist Scott Halpern at the University of Pennsylvania has authored a model guideline that has been heavily circulated by the medical community

Bioethicist Scott Halpern at the University of Pennsylvania has authored a model guideline that has been heavily circulated by the medical community

Bioethicist Scott Halpern at the University of Pennsylvania has authored a model guideline that has been heavily circulated by the medical community. 

Halpern described a blanket stop to resuscitations for infected patients as being too ‘draconian,’ adding that one could cause the loss on a young person who would otherwise be in good health. 

He did advocate for health care workers who have limited protective equipment, saying their needs can’t be ignored. 

‘If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,’ he said.

Under Halpern’s guidelines, two physicians would be needed to make any calls. One would directly work with a patient and the other would have to be one who is not. 

Their joint sign off on do-not-resuscitate orders would have to provide a reasoning for family members.      

Under Halpern's guidelines, two physicians would be needed to sign off on do-not-resuscitate orders. University of Washington's Northwester Outpatient Medical Center is pictured on March 18

Under Halpern’s guidelines, two physicians would be needed to sign off on do-not-resuscitate orders. University of Washington’s Northwester Outpatient Medical Center is pictured on March 18

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Written by Angle News

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