Just a quick thread about ethics of Do Not Resuscitate (DNR) decisions during covid-19 pandemic. We first look at what chances the person has of surviving whatever illness caused the cardiac arrest that we need to resuscitate them from.

Resuscitation is also a very physical intervention. If the person is too frail (due to old age or illness) rescucitation can not just kill them but cause them a lot of pain and suffering. If their chances of survival are very low, the question arises of whether DNR is appropriate

Also, rescucitation is a procedure with high chance of virus aerosolising and transmitting to others. So the question then becomes what is in the patient’s best interest, but also what is in the best interest of other patients and those who are involved in treatment.

Many doctors and nurses have witnesses the tragedy of a very old/frail patient with very limited life expectancy who didn’t have DNR in place being resuscitated, and ending up battered, bruised and dying in terrible pain. It is possibly one of the more horrible things to witness.

People and families often find it shocking when DNR is suggested, and feel let down, like health service doesn’t want to help their loved one. Same goes for suggestions to stop medication for elderly/sick patients who are dying. When taking meds becomes an ordeal,

But stopping them is seen as not doing everything to prevent death. Truth is, ethics of decision to withold further treatment are never easy, but they are robust. Sometimes not doing something is a more humane, merciful option.

Additionally, during a pandemic, healthcare staff has a high risk of becoming infected from doing these procedures. If the patient is assessed medically as having extremely low chance of surviving, is it ethical to discuss and even implenet DNR?

Yes, absolutely. But several things can go wrong. Normally, if a frail patient is insisting on resuscitation against medical advice, an anaesthetist would be asked to make this decision. In the pandemic it’s more likely that this decision will be made by GPs or emergency staff.

The capacity of healthcare workers to devote time to explain and reassure patients that DNR is not a death sentence but rather the reasons why if it came to it, it would be in patient’s best interest not to go through the procedure, is not there in the middle of the pandemic.

And if in the past we could afford to resuscitate those unsuitable patients for the sake of appearances, now it would expose health workers and others present in the vicinity to virulent infection. Ethics is not easy at the best of times, but DNRs do have their place.