A DNAR order is the most suitable option for doctors

By MATTHEW WIKFORS
On April 20, 2020

Photo courtesy of Hackensack Meridian Health, Wikipedia

As the coronavirus pandemic rages across the state, New Jersey hospitals have been struggling to keep up with the influx of COVID-19 patients being admitted. To compound the issue, there is a shortage of ventilators for patients and PPE (personal protective equipment) for hospital staff. 

With a lack of supplies and constant contact with carriers of the disease, many hospital workers have become patients themselves.

As a result, Hackensack Meridian Health, the largest hospital network in the state, has issued a Do Not Attempt Resuscitation (DNAR) order to minimize the risk of staff members contracting the disease. Other hospitals across the state have begun to enact similar measures.

A DNAR order means that nurses and doctors cannot perform CPR or other resuscitation techniques if the need arises on a patient who has tested positive for the disease or is suspected to have it. The measures are a way to eliminate the transmission risks inherent in lifesaving measures like CPR and intubation.

At first glance, these measures seem harsh. Being unable to resuscitate a patient who stops breathing or whose heart stops beating means that the patient will die. It feels immoral for a doctor not to save a life when they have the opportunity to do so. 

It is as if natural selection is taking place before our eyes: healthier patients will be treated and survive while weaker patients who end up suffering breathing problems will die. In normal times, an order like this seems inhumane.

But we are not living in normal times right now. We are in the midst of a pandemic that has claimed the lives of thousands, and we are not even through the worst of it yet. The COVID-19 Hospital Impact Model for Epidemics reports that New Jersey cases will peak on either April 24 or April 25. The worst is yet to come and the decision to issue DNAR orders highlights a bigger issue: the dwindling number of available doctors in hospitals and a lack of supplies.

There is already a shortage of hospital workers across the nation as medical personnel have become infected with the virus through treating patients. In New Jersey, hospitals in Bergen, Essex, Hudson, and Middlesex counties have had to go to a “divert” status, meaning that they are not accepting any new patients at the time. There are also a limited number of supplies, with some hospitals urging medical staff to reuse protective gear or share ventilators with each other, increasing the rate of infection. In such a trying time, the health of those in the medical community should be our top priority. Without them, the number of deaths from the outbreak would be much higher than what they are.

Hospitals are also going about the decision in a moral and ethical way. There are no criteria for who will and will not receive resuscitation under the new DNAR order. Like with any patient during normal times, the decision to resuscitate or not will be case by case. Some COVID-19 patients who go into cardiac arrest or stop breathing may be able to bounce back without the aid of resuscitation. Just as always, health care teams are making their best assessment to help the patients in whatever way they can. 

These are difficult times. It can be scary to lose a connection with a loved one and see them hospitalized. Even with the DNAR measures in place in some hospitals, you should remember that doctors are still trying their best to help anyone they can. The decision for DNAR is not ideal, but it is the best option we have to keep our doctors healthy and our hospitals open.

 

mwikfors@ramapo.edu

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