Mandatory DNRs for COVID patients?!?!
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Tagged: Coronavirus, covid, covid-19
- This topic has 24 replies, 15 voices, and was last updated 3 years, 1 month ago by Reb Eliezer.
April 1, 2020 1:22 pm at 1:22 pm #1845673LoSaamodAlDamReyechaParticipant
According to the Washington Post, several NYC hospitals are considering putting all coronavirus patients on DNRs, regardless of whether the patient and his/her family wants it.
(For those that are unaware, a DNR order – which stands for “Do Not Resuscitate” – means that hospitals will not perform CPR or other lifesaving care when it is necessary; instead, they simply will let the patient die, Rachmana Litzlan.)
Specific hospital policy according to the article:
St. Joseph’s University Medical Center in Paterson, New Jersey is already doing it.
Elmhurst Hospital in Queens sent out a memo telling doctors to do it on Saturday, but rescinded the memo on Tuesday.
Montefiore Medical Center, NYU Langone, and Brooklyn Methodist do not have any such policy officially, but doctors have been doing so without authorization.
Maimonides Medical Center is “actively discussing the move with community and religious leaders.”
Is our community okay with this?April 1, 2020 4:41 pm at 4:41 pm #1845741yldParticipant
What type of question is that? of course we are not okay with it, but what can we do about it?April 1, 2020 4:42 pm at 4:42 pm #1845774
“Is our community okay with this?”
no of course not! who could be “ok” with any of this?
that said we and they don’t have a choice.
Please everybody keep doing your part, stay home as much as possible. I’ts hard to describe what is going on in NYC hospitalsApril 1, 2020 4:43 pm at 4:43 pm #1845817lowerourtuition11210Participant
Ask a poseik, not the CR.April 1, 2020 5:23 pm at 5:23 pm #1845859yldParticipant
ubiquitin, you just repeated what i said. whats the big deal?April 1, 2020 7:36 pm at 7:36 pm #1845804Luna LovegoodParticipant
Performing CPR and attempting to resuscitate the patient results in the spread of the virus, since droplets are expectorated. Doctors and nurses performing such procedures do not have proper PPE and putting their lives at risk.
It’s not an easy decision and it wasn’t made lightly. If our doctors and nurses become ill from performing CPR they will not be able to save the lives of others may die themselves. The goal is to save as many people as possible and once someone becomes so debilitated from COVID-19 that they need to be resuscitated, it’s unlikely they would have survived much longer anyway.
Again, to make such a decision isn’t simple. But we need to focus on saving people who can be saved without increasing the risk to healthcare workers.April 1, 2020 7:45 pm at 7:45 pm #1845903JosephParticipant
For years already many hospitals and doctors have freely and actively been intentionally letting patients die rather than attempt to save their lives, even though they potentially could save their lives, when the doctor decided that a patient’s life isn’t worth living.
The above has been true even when there have been plenty of medical resources without any shortages.April 1, 2020 7:47 pm at 7:47 pm #1845934mattisyahuParticipant
I doubt anyone is okay with this policy, but when they are not able to put people coming in on ventilators who have a chance of living because they are trying to revive a patient who died already (which probably also carries a bigger risk of COVID-19 spreading due to whatever coughing results) not sure what is better (also you need the staff to deal with this). Hopefully does not come to this, but this is what Italy went through.April 1, 2020 7:50 pm at 7:50 pm #1845960
“, you just repeated what i said.”
when I typed my comment yours wasn’t up yet
” whats the big deal?”
i’m not sure what you are referring to
But as to the big deal
here is a report from a frum emergency room physician
“I spent 24 of the last 36 in my ER.
It’s an absolute nightmare.
I personally intubated 3 patients in just under an hour.
We have over 400 patients admitted with coronavirus- 82 of them on ventilators.
To put things in perspective, My ER which is built to have about 80-100 patients, had 172 people ADMITTED with covid 19- crammed into spots, corners and crevices. And all of our ICU and step-down units together can usually handle 50 patients. We are managing ventilators in hallways.
In 22 years of medicine, I’ve never seen the staff look this tired- physically and emotionally drained. At least twice an hour we hear the call overhead that somebody upstairs is in cardiac arrest. This acutely exacerbates our distress. People that we were caring for are dead 12 hours later.
30 year olds. 50 year olds. 70 year olds. Nobody is spared.
We are at the breaking point .
We are out of space in our hospital.
We are out of space in our emergency room.
I was caring for a woman with an oxygen level at 64% and I had to have her sitting in a chair for an hour until I could find a stretcher.
Multiple doctors in the hospital are out sick with the virus.
I’m caring for patients in their homes and as long as their oxygen level is above 90% I’m trying to keep them from going to the hospital.”
I can attest to every word.
This is a very big dealApril 1, 2020 7:54 pm at 7:54 pm #1845986LightbriteParticipant
Luna Lovegood: Thank you for sharing such pertinent information! I thought that the DNR issue was just about not having enough ICU-space/ventilators… the fact that resuscitating someone would risk other’s lives (even more so) might be a rodef situation (?) or at least, yes, not an easy decision, and yet necessary.
Much appreciatedApril 2, 2020 8:13 am at 8:13 am #18460872scentsParticipant
Oh please coding a patient is now an act of retzicha?!
This is more than just dnr/dni, in the hospital setting, people that have advanced directives are not cared for as aggressively, they are written off very quickly, despite not being in arrest or needing intubation.
But more so, the progressive mindset is that older people with a smaller ypl don’t deserve the same care as a younger patient.
This is not new and very sad.April 2, 2020 8:13 am at 8:13 am #18460882scentsParticipant
The doctor that posted this does not subscribe to the notion of sacrificing older patients so there are more resources for younger more viable patients.
In fact, he is also a member of one of the nyc hatzolas which is aggressively advocating for elderly patients.April 2, 2020 8:14 am at 8:14 am #1846092takahmamashParticipant
Joseph, I’m sure you have a cite and/or source for your allegations. I’d like to see them. Perhaps others would as well. Can you please post?April 2, 2020 8:18 am at 8:18 am #1846115reform rabbiParticipant
There is no mitzvah to revive a person who’s heart stopped because if the heart is stopped then the patient is dead according to Jewish law.
In general, medicine is allowed, but not obligated, in Jewish law.April 2, 2020 8:48 am at 8:48 am #1846141
“The doctor that posted this does not subscribe to the notion of sacrificing older patients so there are more resources for younger more viable patients.”
My family knows him quite well.
And Of course he does. Though he (and I) probably wouldn’t describe it that way)
When he has 2 patients crashing at once one has been on vent for past 2 weeks and getting worse the other just showed up and had been stable until now.
How does he decide who to help?
Does he flip a coin ?
Of course he chooses who he thinks is more likely to benefit whether consciously or subconsciouslyApril 2, 2020 9:00 am at 9:00 am #1846158
Ubiq – I’m surprised at you!
Of course he chooses who he thinks is more likely to benefit
Is absolutely NOT an example of sacraficing older patients SO THAT there will be more resources for the young! Not at all.April 2, 2020 10:30 am at 10:30 am #1846170
As I said “Though he (and I) probably wouldn’t describe it that way)”
Sadly though (arguably) it is sacrificing. Time too is a finite resource. In the regular world even if there is a remote chance of survial doctors will try (to an extent) to revive patients. Worst case time was spent “for nothing” nu nu so the doctor goes without luch that day small price to pay for a chance at saving someone.
Here we are in a whole other world as he said (At least twice an hour we hear the call overhead that somebody upstairs is in cardiac arrest; To put that in context in regular times it isnt even daily – though of course depends on hopital).
Now it isnt lunch time that is being given up to try to save a patient who will most likely not make it. It is a nother patient who has a chance. Time spent trying to save one will have to be sacrificed to try to save the other.
How do you decide who to save , is an important question
you can flip a coin?
make a judgment call who is more likely to survive?
make a judgment call who is more likely to gain?
kal dalum gvar?
whoever pays you more?
first come first serve?
Give precedence to societal factors (a kohein more choshuv a talmud chochom) ?
but somehow a decision has to be made who to save and who to leave (“sacrifice?”)April 2, 2020 10:52 am at 10:52 am #1846197
You’re doing it again. I don’t disagree with any of what you write but it is NOT an answer to the claim you are tying it to. You cannot make a comment that a doctor subscribes to letting old people go to save the resources for young people based on a situation that does not in any way illustrate that point. You are bringing “supporting evidence” that describes an in the moment need to address two individuals, viable and not viable, and chosing viable with deciding to leave supplies in the storage room just in case a younger person happens to need it. There is no comparison and it might be motzei shem rah to claim he ascribes to the later.April 2, 2020 10:52 am at 10:52 am #1846199
For example, viable vs non viable (your scenario) does not mean old vs young.
When my dad was in the hospital, they told me it was a shame to “waste” O- blood on him when someone younger may be able to benefit from it. There was no such young person there at the time. THAT is an example of letting the elderly go to save resources for the young.April 2, 2020 3:52 pm at 3:52 pm #1846238HealthParticipant
Ubiq -“How does he decide who to help?
Does he flip a coin ?
Of course he chooses who he thinks is more likely to benefit whether consciously or subconsciously”
I would do the same thing!
Once everybody does Teshuva, then Hashem will release the cure.
I posted this in the other topic:
“BTW, I’m trying to work with pharmaceutical companies to initiate treatments, that I’m sure will work.”April 2, 2020 3:53 pm at 3:53 pm #1846309
“You’re doing it again.”
” I don’t disagree with any of what you write”
Great. that is ok. People dont have to disagree. I’m not sure why that is a problem.
” but it is NOT an answer to the claim you are tying it to. ”
I’m not sure what claim you think it is tied to. (I posted it in repsonse to ” whats the big deal?”) This is a thread about DNR’s against patient’s wishes (see the OP) . My point is that By choosing one patient over another, then by definition you are making the patient you don’t tend to DNR even against his/family wishes.
“. You cannot make a comment that a doctor subscribes to letting old people go to save the resources for young people based on a situation that does not in any way illustrate that point”
It depends on how you define resources. If time is a resource then it is an example. If not not you dont have to agree with said example. Again though that wasnt what this thread is about if you dont think time counts as a resource fine then this isnt an example.
. You are bringing “supporting evidence” that describes an in the moment need to address two individuals, viable and not viable, and chosing viable with deciding to leave supplies in the storage room just in case a younger person happens to need it. ”
Sadly it isnt “just in case” It is for a certainty. See The Teshuva by Rabbi Shechter .
“For example, viable vs non viable (your scenario) does not mean old vs young.”
Without question this is true. though in tends that way. but you are of course correct.
” There was no such young person there at the time.”
I’m sorry to hear about that unacceptable incident. but is not the situation we face today.
“THAT is an example of letting the elderly go to save resources for the young.”
This thread is not about ” letting elderly go to ave the young ” it is about making a patient. DNR against their wishes. My quoting Eli was NOT to say he was “letting elderly go to save the young” ( again that isnt the topic of this thread) I quoted him to dispell this notion that blood is being banked for later, and items being “left in storage” there are 2 cardiac arrests an hour tending to those alone would leave no time for anything else. There is no room in the ER, patients are kept in chairs. Yet some people are under the impression that they “leave supplies in the storage room just in case …” THAT was what I was trying to dispell.April 2, 2020 3:54 pm at 3:54 pm #1846333
I’m worried you arent following the flow, especially since other comments get added later so here is a brief recap:
OP – “Mandatory DNRs for COVID patients?!?!,,, Is our community okay with this?”
Ubiq- no we arent ok with it but what choice is there.
Then to illustrate how severe things are I posted a description by an MD
2scents “The doctor that posted this does not subscribe to the notion of sacrificing older patients so there are more resources for younger more viable patients.”
(now I assume this was in response to my comment , in which I acknowledged that there was no choice with regard to unilateral DNR’s and not a brand new topic)
so I replied: That of course he supports unilateral DNR’s (the topic of the thread) though he and I wouldnt necessarily describe it as “sacrificing older patient”
Then you said “Of course he chooses who he thinks is more likely to benefit [from his time] Is absolutely NOT an example of sacraficing older patients…”
I acknowledged again that he/I woudlnt describe it that way, and I have no problem if you disagree with that description. but by giving your limited time to save one patient over another you are sacrificing one for the other.
but again if you dont think that that is an example then fine, if you dont think it is relevent to this thread (I posted it to show how serious the situation is) fine this topic is about DNR’ against the patients wishes.April 13, 2020 9:22 am at 9:22 am #1849157
וכן נראה שאם כבר חברו את הזקן המופלג לונטיליטור, ואח”כ הבינו שלא הי’ כדאי, כי הרבה צעירים יבואו עוד, שמן
כי לגבי התחלת הטיפול החדש עבור החולה הזקן בנגוד לטפול ,DNR הנכון לרופאים לקבוע על הזקן הזה החלטה של
בצעירים, זה כבר נחשב כבאו בב”א, ועלינו להקדים הטפול בצעירים הבריאים, ואין בזה משום אין דוחים נפש מפני נפש,
כי אין כאן רציחה בקו”ע, אלא רק אי-קיום הדין של לא תעמוד על דם רעך, ובאם אין ביכולתו של הרופא לטפל בכולם
ביחד, צריך להקדים את אלו שיצא מהם יותר ריוח לקהילה, וכאמור.
Above is from R’ Shachters Teshuva on the topic entitled Piskei Corona #15: Triage in Medical DecisionsApril 17, 2020 1:36 am at 1:36 am #1849857charliehallParticipant
“Doctors and nurses performing such procedures do not have proper PPE and putting their lives at risk.”
Judaism does NOT require you to sacrifice your own life to save another.
We who are not on the front lines risking our lives have no business questioning anyone who is.April 22, 2020 3:55 pm at 3:55 pm #1851977
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