Do-Not-Resuscitate Policies for Coronavirus Patients: A Controversial but Necessary Approach

The recent consideration by hospitals in the United States of standard “do not resuscitate” (DNR) policies for coronavirus patients has sparked intense debate. Supporters argue that such policies are essential for cost-effectiveness and ethical reasons, while critics voice concerns about the quality of care and the potential for misinterpretation. This article explores the rationale behind these policies and their implications for patients and healthcare providers.

Medical Ethics and Cost-Effectiveness

Healthcare is a high-cost industry, and the treatment of critically ill patients can be particularly resource-intensive. The do-not-resuscitate (DNR) policy is rooted in the principles of medical ethics and cost-effectiveness. Palliative care, which aims to improve the quality of life for patients and their families, is more aligned with the goals of comfort and symptom management.

As one respondent pointed out, "In fact, since care is so expensive, seriously ill patients should only be given palliative care." This perspective emphasizes the ethical consideration of resource allocation, ensuring that limited medical resources are used to provide the most meaningful and humane care possible.

Patient Survival Rates and Clinical Practice

The effectiveness of resuscitation in coronavirus patients is often debated. For example, the response, "It is a wise policy. In fact, since care is so expensive, seriously ill patients should only be given palliative care," highlights a pragmatic view based on survival rates and the burden of intensive care.

One user shared their personal experience with a family member who had Acute Respiratory Distress Syndrome (ARDS) due to lung surgery. Despite multiple resuscitations, their father's condition did not improve significantly. The user mentions, "I think when a COVID-19 patient has reached that state after being in ICU, supplemental oxygen, intubation, and CPR is probably not going to save them." This case underscores the reality that advanced life support may not always be effective, particularly in critically ill patients.

Historical Context and Clinical Practices

The case of the user's father also highlights the variability in clinical practices and the impact of medical interventions. The user recalls, "Don’t know anything about ARDs with COVID-19 but my Father had ARDS right after lung surgery and was on a ventilator for 2 months. He coded and they brought him back at least two times. So I know that people can survive in some circumstances." This example shows that while survival is possible in some patients, the outcomes can be exceedingly grim and resource-intensive.

Further, the user noted, "They finally got him to breathe on his own with steroids. I’m wondering why they don’t do that anymore. Always had the feeling that if they had known about the steroids he would have only had to stay on the respirator for a couple of days." This highlights the potential for alternative treatments and the importance of staying informed about evolving medical knowledge and practices.

Ethical Concerns and Personal Reflections

The ethical implications of DNR policies are complex. The user reflects on the decisions made for their stepfather: "He died 1 year later though because the cancer couldn’t be treated and moved to his other lung. His hips had also melded together either from being in bed for so long or from the steroids. He wished that he hadn’t survived. The hospital had basically written him off but my step-mother got them to experiment with the steroids because he had told her that his children were written into his will right before the intubation. She got him out of there you wouldn’t believe the story behind what she did and had him re-write his will they took a disastrous trip to Hawaii and then he went back to the hospital." These experiences underscore the personal and emotional aspects of medical decisions.

The user concludes, "So I think these hospital employees who say it can’t be done are probably not very good at their jobs. And I also would never want to go on a respirator from what I saw so maybe it’s best to have mediocre doctors especially if you have a greedy step-family." This perspective reflects the desire for better medical care and the impact of personal and professional relationships on healthcare decisions.

Conclusion

The debate over DNR policies for coronavirus patients is multifaceted. While these policies may be seen as controversial, they are driven by a combination of ethical, economic, and clinical considerations. The decision to implement such policies should be guided by a nuanced understanding of the patient’s wishes, the potential outcomes, and the ethical responsibilities of healthcare providers. As society continues to grapple with the challenges of pandemic care, it is crucial to balance compassion with practicality and to ensure that every patient receives the most appropriate and compassionate care possible.