DNR and COVID-19: The Ethical Dilemma and Suggested Solutions

被引:16
作者
Sultan, Hala [1 ]
Mansour, Razan [2 ]
Shamieh, Omar [3 ]
Al-Tabba, Amal
Al-Hussaini, Maysa [4 ]
机构
[1] Univ Jordan, Sch Med, Amman, Jordan
[2] Univ Kansas, Outcomes & Implementat Res Unit, Dept Internal Med, Med Ctr, Kansas City, MO USA
[3] King Hussein Canc Ctr, Dept Palliat Care, Amman, Jordan
[4] King Hussein Canc Ctr, Human Res Protect Program, Amman, Jordan
关键词
COVID-19; do not resuscitate; ethics; healthcare; Pandemic; NOT-RESUSCITATE ORDERS; ASSOCIATION; DECISIONS;
D O I
10.3389/fpubh.2021.560405
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Ethics are considered a basic aptitude in healthcare, and the capacity to handle ethical dilemmas in tough times calls for an adequate, responsible, and blame-free environment. While do-not-resuscitate (DNR) decisions are made in advance in certain medical situations, in particular in the setting of poor prognosis like in advanced oncology, the discussion of DNR in relation to acute medical conditions, the COVID-19 pandemic in this example, might impose ethical dilemmas to the patient and family, healthcare providers (HCPs) including physicians and nurses, and to the institution. The literature on DNR decisions in the more recent pandemics and outbreaks is scarce. DNR was only discussed amid the H1N1 influenza pandemic in 2009, with clear global recommendations. The unprecedented condition of the COVID-19 pandemic leaves healthcare systems worldwide confronting tough decisions. DNR has been implemented in some countries where the healthcare system is limited in capacity to admit, and thus intubating and resuscitating patients when needed is jeopardized. Some countries were forced to adopt a unilateral DNR policy for certain patient groups. Younger age was used as a discriminator in some, while general medical condition with anticipated good outcome was used in others. The ethical challenge of how to balance patient autonomy vs. beneficence, equality vs. equity, is a pressing concern. In the current difficult situation, when cases top 100 million globally and the death toll surges past 2.7 million, difficult decisions are to be made. Societal rather than individual benefits might prevail. Pre-hospital triaging of cases, engagement of other sectors including mental health specialists and religious scholars to support patients, families, and HCPs in the frontline might help in addressing the psychological stress these groups might encounter in addressing DNR in the current situation.
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页数:7
相关论文
共 63 条
[1]  
Arai T, 1994, Masui, V43, P600
[2]  
Association AH, 2020, CPR 1 AID EM CARD CA
[3]   Differentiating DNI From DNR: Combating Code Status Conflation [J].
Breu, Anthony C. ;
Herzig, Shoshana J. .
JOURNAL OF HOSPITAL MEDICINE, 2014, 9 (10) :669-670
[4]  
Brooks M., 2020, AHA GUIDANCE CPR EME
[5]   Postoperative outcomes in patients with a do-not-resuscitate (DNR) order undergoing elective procedures [J].
Brovman, Ethan Y. ;
Walsh, Elisa C. ;
Burton, Brittany N. ;
Kuo, Christine E. ;
Lindvall, Charlotta ;
Gabriel, Rodney A. ;
Urman, Richard D. .
JOURNAL OF CLINICAL ANESTHESIA, 2018, 48 :81-88
[6]   HISTORY OF MEDICINE The DNR Order after 40 Years [J].
Burns, Jeffrey P. ;
Truog, Robert D. .
NEW ENGLAND JOURNAL OF MEDICINE, 2016, 375 (06) :504-506
[7]  
CARTER LJ, 1979, SCIENCE, V204, P924
[8]   DNR, DNI, and DNO? [J].
Cauley, Christy E. ;
El-Jawahri, Areej R. ;
Jacobsen, Juliet C. ;
Udelsman, Brooks, V ;
Jackson, Vicki A. ;
Temel, Jennifer S. ;
Qadan, Motaz .
JOURNAL OF PALLIATIVE MEDICINE, 2020, 23 (06) :829-831
[9]   Code Blue During the COVID-19 Pandemic [J].
Chan, Paul S. ;
Berg, Robert A. ;
Nadkarni, Vinay M. .
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2020, 13 (05) :261-263
[10]   Increasing use of DNR orders in the elderly worldwide: whose choice is it? [J].
Cherniack, EP .
JOURNAL OF MEDICAL ETHICS, 2002, 28 (05) :305-309