DNR and COVID-19: The Ethical Dilemma and Suggested Solutions

Ethics are considered a basic aptitude in healthcare, and the capacity to handle ethical dilemmas in tough times calls for an adequate, responsible, and blame-free environment. While do-not-resuscitate (DNR) decisions are made in advance in certain medical situations, in particular in the setting of...

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Main Authors: Hala Sultan, Razan Mansour, Omar Shamieh, Amal Al-Tabba', Maysa Al-Hussaini
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-05-01
Series:Frontiers in Public Health
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2021.560405/full
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spelling doaj-369f5e6b57444372a33240fb76e638cf2021-05-12T04:15:04ZengFrontiers Media S.A.Frontiers in Public Health2296-25652021-05-01910.3389/fpubh.2021.560405560405DNR and COVID-19: The Ethical Dilemma and Suggested SolutionsHala Sultan0Razan Mansour1Omar Shamieh2Amal Al-Tabba'3Maysa Al-Hussaini4School of Medicine, University of Jordan, Amman, JordanOutcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United StatesDepartment of Palliative Care, King Hussein Cancer Center, Amman, JordanIndependent Researcher, Amman, JordanHuman Research Protection Program, King Hussein Cancer Center, Amman, JordanEthics are considered a basic aptitude in healthcare, and the capacity to handle ethical dilemmas in tough times calls for an adequate, responsible, and blame-free environment. While do-not-resuscitate (DNR) decisions are made in advance in certain medical situations, in particular in the setting of poor prognosis like in advanced oncology, the discussion of DNR in relation to acute medical conditions, the COVID-19 pandemic in this example, might impose ethical dilemmas to the patient and family, healthcare providers (HCPs) including physicians and nurses, and to the institution. The literature on DNR decisions in the more recent pandemics and outbreaks is scarce. DNR was only discussed amid the H1N1 influenza pandemic in 2009, with clear global recommendations. The unprecedented condition of the COVID-19 pandemic leaves healthcare systems worldwide confronting tough decisions. DNR has been implemented in some countries where the healthcare system is limited in capacity to admit, and thus intubating and resuscitating patients when needed is jeopardized. Some countries were forced to adopt a unilateral DNR policy for certain patient groups. Younger age was used as a discriminator in some, while general medical condition with anticipated good outcome was used in others. The ethical challenge of how to balance patient autonomy vs. beneficence, equality vs. equity, is a pressing concern. In the current difficult situation, when cases top 100 million globally and the death toll surges past 2.7 million, difficult decisions are to be made. Societal rather than individual benefits might prevail. Pre-hospital triaging of cases, engagement of other sectors including mental health specialists and religious scholars to support patients, families, and HCPs in the frontline might help in addressing the psychological stress these groups might encounter in addressing DNR in the current situation.https://www.frontiersin.org/articles/10.3389/fpubh.2021.560405/fullCOVID-19do not resuscitateethicshealthcarePandemic
collection DOAJ
language English
format Article
sources DOAJ
author Hala Sultan
Razan Mansour
Omar Shamieh
Amal Al-Tabba'
Maysa Al-Hussaini
spellingShingle Hala Sultan
Razan Mansour
Omar Shamieh
Amal Al-Tabba'
Maysa Al-Hussaini
DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
Frontiers in Public Health
COVID-19
do not resuscitate
ethics
healthcare
Pandemic
author_facet Hala Sultan
Razan Mansour
Omar Shamieh
Amal Al-Tabba'
Maysa Al-Hussaini
author_sort Hala Sultan
title DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
title_short DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
title_full DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
title_fullStr DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
title_full_unstemmed DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
title_sort dnr and covid-19: the ethical dilemma and suggested solutions
publisher Frontiers Media S.A.
series Frontiers in Public Health
issn 2296-2565
publishDate 2021-05-01
description Ethics are considered a basic aptitude in healthcare, and the capacity to handle ethical dilemmas in tough times calls for an adequate, responsible, and blame-free environment. While do-not-resuscitate (DNR) decisions are made in advance in certain medical situations, in particular in the setting of poor prognosis like in advanced oncology, the discussion of DNR in relation to acute medical conditions, the COVID-19 pandemic in this example, might impose ethical dilemmas to the patient and family, healthcare providers (HCPs) including physicians and nurses, and to the institution. The literature on DNR decisions in the more recent pandemics and outbreaks is scarce. DNR was only discussed amid the H1N1 influenza pandemic in 2009, with clear global recommendations. The unprecedented condition of the COVID-19 pandemic leaves healthcare systems worldwide confronting tough decisions. DNR has been implemented in some countries where the healthcare system is limited in capacity to admit, and thus intubating and resuscitating patients when needed is jeopardized. Some countries were forced to adopt a unilateral DNR policy for certain patient groups. Younger age was used as a discriminator in some, while general medical condition with anticipated good outcome was used in others. The ethical challenge of how to balance patient autonomy vs. beneficence, equality vs. equity, is a pressing concern. In the current difficult situation, when cases top 100 million globally and the death toll surges past 2.7 million, difficult decisions are to be made. Societal rather than individual benefits might prevail. Pre-hospital triaging of cases, engagement of other sectors including mental health specialists and religious scholars to support patients, families, and HCPs in the frontline might help in addressing the psychological stress these groups might encounter in addressing DNR in the current situation.
topic COVID-19
do not resuscitate
ethics
healthcare
Pandemic
url https://www.frontiersin.org/articles/10.3389/fpubh.2021.560405/full
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