A DNR is a doctor’s order in your medical record directing medical staff not to resuscitate you if your heart stops beating or you stop breathing. (DNR stands for “Do Not Resuscitate.”) Under ordinary circumstances, only you can request a doctor to add a DNR order to your medical chart. But the coronavirus (COVID-19) pandemic is putting normal DNR procedures to an unprecedented test.
People most often ask for DNR orders at the end of life, when they are very close to death from a progressive, terminal illness or old age. Without such an order in place, doctors have long been bound by duty—and in many states, by law—to do all they reasonably can to save the life of a patient in crisis. When a hospitalized patient goes into cardiac or respiratory arrest, this usually means activating a “code blue” alarm to initiate resuscitation procedures (CPR).
CPR presents at least two practical dangers in a pandemic environment, where minimizing transmission is vital and essential medical supplies are limited. First, according to a recent article in The Washington Post, between eight and 30 health care workers usually respond to deliver life-saving medical treatment to a patient who codes. The same article describes in detail the ways in which invasive CPR procedures expose these first responders to bodily fluids, putting them at high risk for infection.
Second, responding to patients in cardiac or respiratory arrest requires hospitals to burn through essential protective gear at a time when many facilities are in dire need of masks, head coverings, air-purification systems, and other necessary equipment.
These difficult truths put hospitals in an inextricable ethical bind, weighing the possibility of saving one life against putting others at risk.
So far, hospitals are continuing to resuscitate COVID-19 patients who don’t have DNR orders in place. But many—including Northwestern Memorial in Chicago, George Washington University Hospital, and Kaiser Permanente’s facilities—are considering guidelines that could allow doctors in some circumstances to ignore a patient’s wish to receive CPR. It won't be easy to make changes like these. Both the Hippocratic Oath and the laws of many states would seem to stand against them but, as we all know, desperate times can lead to unconventional measures.
For now, the very best thing you can do is to help lighten the load on our health care system by staying home, avoiding infection, and flattening the curve. But if you or a loved one ends up hospitalized with a coronavirus infection, you should be prepared for a conversation about the hospital’s DNR policy. Many facilities are now initiating such conversations with patients and their families. (As they do, we can hope that they have more sensitivity than the general surgery practice in the U.K. that got in hot water for asking seriously ill patients to sign DNR orders to, among other things, make ambulances more available to the “young and fit” who have a greater chance of surviving the virus.)
While you are well, give thought to what you would want if you were hospitalized with COVID-19. Talk to those closest to you about your wishes, take time to write them down, and don’t wait to let doctors know how you feel.
To learn more about DNR orders and ways to direct your health care wishes, see the Living Wills & Medical Powers of Attorney area of Nolo.com.