Ethical Aspects of “Do Not Resuscitate” Orders in the Context of the Covid-19 Pandemic

Abstract

” Do not resuscitate” order (DNR) is issued to avoid cardio-pulmonary resuscitation in situations when it becomes futile. Like any other medical procedure, it's based on the “maximum benefit – minimum risk” principle, on one hand, while also respecting the patient's autonomy and dignity. However, they are influenced by the urgency of the situation and the patient's inability to decide. The COVID-19 pandemic poses additional challenges for the process of taking a decision regarding resuscitation. The number of those who need intensive care is increasing daily and, implicitly, of the situations in which it is necessary to make decisions regarding resuscitation. In the meanwhile, health systems across the world are overwhelmed, lacking equipment, and medical staff. Doctors are facing the situation when they should assume, with a great moral burden, the responsibility for the DNR decision, taken unilaterally, by a pragmatic approach, justified by the potential wasting of time and resources, and exposure to the virus. Such a paternalistic approach ignores the patient's view on his/her own treatment, depriving him/her of the right to autonomy. However, when the alternative is death, whatever the risk, it should be accepted. It becomes a problem to determine the extent and conditions of such a decision. The international data on the DNR decisions taken by doctors and the criteria on which they were based are analyzed in the article. The authors conclude that when it is difficult to resuscitate all patients, and the DNR decision is ethically unacceptable, creating a protocol dedicated to the state of crisis, which would protect both doctors and patients is of critical importance.