Doctors are known for 'saving the patient at all costs.' The coronavirus pandemic has started debates in hospitals and governments about 'should we try saving all patients unconditionally?'

Resuscitating a patient dying of COVID-19 has encountered dangers of exposing doctors and nurses to the coronavirus contagion. The ideas is, not just about health-care workers getting infected but carrying the virus to other patients in the time of dwindling stores of protective equipment - such as masks, gowns and gloves.

The Northwestern Memorial Hospital in Chicago has been discussing about universal do-not-resuscitate (DNR) policy for infected patients, regardless of the wishes of the patient or their family members. This is an ethical question! Would it mean prioritizing the lives of the many over one?

What is Reuscitation?

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Representational image Xinhua/IANS

Dictionary meaning of the word is to revive from apparent death or from unconsciousness. Doctors perform it usually when a patient is not breathing or when the heart stops. The procedures are well known as cardiopulmonary (CPR) and mouth-to-mouth resuscitation to revive a patient.

Hospital administrators, recognizing the risk of coronavirus contraction during such procedures have asked Illinois Governor JB Pritzker for help in understanding the state law and how it would permit a policy shift, said Richard Wunderink, one of Northwestern's intensive-care medical directors, The Washington Post reported.

George Washington University Hospital in Washington says it would continue to resuscitate COVID-19 patients using modified procedures, like putting plastic sheeting over the patient as a barrier.

Bioethicist guides

A Bioethicist Scott Halpern at the University of Pennsylvania who authored a widely circulated model guideline that's considered by many hospitals said in an interview, that it is too "draconian" on deciding to stop resuscitations for infected patients as one may end up sacrificing a young person who is otherwise in good health. The fact that there is limited protective equipment cannot be ignored, he opined.

"If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair," he said. His guideline calls for two physicians, that is the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders by recording the reasons for it. However, the family must be informed irrespective of their agreement to it. Wunderink said that many family members were making the difficult choice to sign do-not-resuscitate orders.

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Novel Coronavirus SARS-CoV-2 Wikimedia Commons

Bound by oath and law

Health-care service providers are bound by oath and also by law in some states. That is to do everything within the bounds of modern technology while save a patient provided there are no DNR orders. As COVID-19 cases and shortage of essentials mount, hospitals are beginning to implement emergency measures that would either minimize, modify or stop using certain procedures on COVID-19 patients, as reported.

Health-care workers involve participating in procedures like endoscopies, bronchoscopes among others that send virus-laced droplets from a patient's airways all over the room. Changing or eliminating such procedures would likely to decrease patients' chances for survival, at the same time are necessary to save the most lives.

Dangerous procedures

When a patient has gone into cardiopulmonary arrest usually around eight to maximum 30 medical personnel would rush into the room, to start live-saving procedures that involves coronavirus infection risk from multiple bodily fluids. This, the doctors say, are dangerous.

Bruno Petinaux, chief medical officer at George Washington University Hospital, said "From a safety perspective you can make the argument that the safest thing is to do nothing" However he does not believe that it would be 'necessarily the right approach.'

"So we have decided not to go in that direction. What we are doing is what can be done safely," he added.

Similar proposal in Italy

Earlier this month,Telegraph reported that it saw a proposal by civil protection department of the Piedmont region of Italy that says it would "leave patients over the age of 80 to die...if the situation becomes of such an exceptional nature as to make the therapeutic choices on the individual case dependent on the availability of resources," while the ability of the coronavirus patient to recover from resuscitation would also be considered.

One doctor reportedly said: "[Who lives and who dies] is decided by age and by the [patient's] health conditions. This is how it is in a war." Overall deaths caused by COVID-19 in the United States have risen to more than 1,000 with more than 69,100 confirmed cases. There have been 619 recoveries as of Thursday morning.