With US Now Epicenter of Global Pandemic, Hospitals Forced to Consider 'Do Not Resuscitate' Orders for Patients

As the United States becomes the global epicenter of the coronavirus pandemic with more than 85,000 cases spread across the nation, healthcare workers around the country are increasingly facing difficult decisions about whether life-saving measures can be taken for some of the sickest coronavirus patients.

Two weeks ago, when fewer than 3,000 cases of the disease--officially called COVID-19--had been reported in the U.S., Americans read about doctors in Italy being forced to practice "catastrophe medicine," with medical experts recommending physicians take patients' age and any comorbidities--meaning other health conditions or diseases--into account before using resources to offer intensive care.

"Elites in this country have long tolerated a dysfunctional health care system because, while it delivers relatively poor results for many people, it provides good care for those at the top. But now Americans of all classes are going to be competing for the same scarce health resources."
--Michelle Goldberg, New York Times

According to reporting by the Washington Post and other outlets, those same decisions are now being made in hospital systems across the United States.

As the Post reported, Northwestern Memorial Hospital officials in Chicago are considering a Do Not Resuscitate (DNR) policy for infected patients to cope with a shortage of Personal Protective Equipment (PPE) including masks, gloves, and gowns for doctors and nurses--putting healthcare workers at risk as they struggle to save as many lives as possible.

As Common Dreams reported last week, 250 doctors and nurses reported critical shortages of PPE in a survey by NBC News. Caregivers are being forced to reuse or ration N95 and surgical masks, and a nursing manager at Mt. Sinai Hospital in New York died from COVID-19 Tuesday following reports that nurses at the renowned hospital were being forced to wear trash bags instead of medical-grade protective gowns.

According to the Post, medical staffers at the hospital are informing family members of coronavirus patients that if their loved ones decline and go into cardiac or respiratory arrest, the PPE shortage is making it difficult for doctors and nurses to safely resuscitate the patient.

"A consequence of those conversations," intensive care medical director Richard Wunderink told the Post, "is that many family members are making the difficult choice to sign do-not-resuscitate orders."

In Michigan, the Henry Ford Health System confirmed to the Detroit Free Press on Friday the veracity of a hospital memo that circulated this week in which medical officers informed patients and their families that "because of shortages, we will need to be careful with resources."

"If you (or a family member) becomes ill and your medical doctor believes that you need extra care in an Intensive Care Unit (ICU) or Mechanical Ventilation (breathing machine) you will be assessed for eligibility based only on your specific condition," the hospital network wrote. "Some patients will be extremely sick and very unlikely to survive their illness even with critical treatment. Treating these patients would take away resources for patients who might survive."

The letter was sent to prepare the communities served by the Henry Ford Health System for the "worst case scenario," Dr. Adnan Munkarah told the Free Press.

"With a pandemic, we must be prepared for worst case," the network tweeted. "With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them."

Atrium Health, Geisinger Health System, and regional Kaiser Permanente medical centers are also considering overriding their DNR policies because of the shortage of PPE and life-saving equipment such as ventilators, according to the Post.

The news of doctors and nurses being forced to ration care comes as President Donald Trump has refused for weeks to invoke the Defense Production Act to order private companies to produce medical equipment, and objected to $1 billion in federal spending to order the production of tens of thousands of ventilators by General Motors.

Trump's refusal to take action in order to help save lives and support overwhelmed healthcare workers called to mind for some critics the right-wing "death panels" narrative which was deployed by opponents of the Affordable Care Act during the Obama administration.

On Friday morning, Trump appeared to invoke the Defense Production Act in a series of tweets.

"America is not alone in facing such harrowing calculations," wrote columnist Michelle Goldberg at the New York Times this week, noting the decisions made by doctors in Italy. "But with our hyper-privatized and grossly unequal health care system, the crisis here could be even worse."

"Elites in this country have long tolerated a dysfunctional health care system because, while it delivers relatively poor results for many people, it provides good care for those at the top," Goldberg wrote. "For a lucky few, everything ugly and unfair about American health care might, in the past, have seemed like someone else's problem."

"But now Americans of all classes are going to be competing for the same scarce health resources," she added.