Abstract
The COVID-19 Pandemic a stress test for clinical medicine and medical ethics, with a confluence over questions of the proportionality of resuscitation. Drawing upon his experience as a clinical ethicist during the surge in New York City during the Spring of 2020, the author considers how attitudes regarding resuscitation have evolved since the inception of do-not-resuscitate (DNR) orders decades ago. Sharing a personal narrative about a DNR quandry he encountered as a medical intern, the author considers the balance of patient rights versus clinical discretion, warning about the risk of resurgent physician paternalism dressed up in the guise of a public health crisis.
Highlights
The COVID-19 Pandemic a stress test for clinical medicine and medical ethics, with a confluence over questions of the proportionality of resuscitation
The doctors in the Emergency Department and across the hospital were imploring us to sanction unilateral do-not-resuscitate (DNR) orders, something that is not permitted under New York State law
One could argue that whatever risks might accrue have to be understood in a context where death is the alternative. These are fair arguments but miss a larger point: in a pandemic, proportionality is more complicated than a consideration of burdens and benefits as they devolve onto a patient.[6]
Summary
One could argue that whatever risks might accrue have to be understood in a context where death is the alternative These are fair arguments but miss a larger point: in a pandemic, proportionality is more complicated than a consideration of burdens and benefits as they devolve onto a patient.[6] There are broader safety and resource allocation questions that must be considered. When proportionality is considered in this broader context, risks and benefits—such as they are—accrue to the patient, significant risks accrue to clinicians performing the resuscitation This is the time healthcare workers are most vulnerable to contagion. If clinicians become sick in the performance of interventions without utility, they will be unable to provide care that is useful to other patients who might benefit from their ministrations All this would seem to make for an airtight case for unilateral DNR orders during a pandemic. I suspect they do and would not want the reader to think that I believe otherwise with crisis standards of care prevailing during a pandemic
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