Thursday, March 26, 2020
The COVID-19 pandemic is raging in hospitals across the country, and along with it is a stark conversation: how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion. The debate is being driven by the knowledge that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops. When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel — usually eight but could be as many as 30 people — rush into the room to begin live-saving procedures without which the person would almost certainly perish.
Administrators at a number of hospitals are discussing a universal do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a truly gut-wrenching decision to prioritize the lives of the many over the one. Northwest Memorial Hospital in Chicago asked Illinois Govenor J.B. Pritzker for assistance in clarifying state law and whether it permits the policy shift. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for COVID-19 infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.
Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at several institutions are sharing drafts of their shifting policies to address their changed reality. “We are now on crisis footing,” he said. “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.”
See Ariana Eunjung Cha, Hospitals Consider Universal Do-Not-Resuscitate Orders for Coronavirus Patients, Washington Post, March 25, 2020.
Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.