NY state first issues, then rescinds do-not-resuscitate order amid COVID-19

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Martin Bürger

Thu Apr 23, 2020 - 2:15 pm EST

ALBANY, New York, April 23, 2020 (LifeSiteNews) – Amid the ongoing coronavirus pandemic, on April 17 the state of New York issued a do-not-resuscitate guideline for any patient found in cardiac arrest – telling paramedics not to try to revive people if there was no beating heart.

However, within hours of the New York Post first reporting on the drastic measure on April 21, Howard A. Zucker, the Commissioner of Health for New York State, announced that the do-not-resuscitate (DNR) guideline would be rescinded. Thus, at a minimum, first responders will still work on patients for 20 minutes by providing CPR.

Marie T. Hilliard, co-chair of the Catholic Medical Association’s ethics committee, told LifeSiteNews that the proposal, “in ethical terms, is a utilitarian approach where the individual patient no longer is the focus.”

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“Not only is patient trust eroded, but also societal trust in the healing professions is lost,” continued Hilliard, a registered nurse, trained canon lawyer, and expert in education. 

“If there is a shortage of equipment, such as ventilators (which currently has been deemed not to be the case in the United States), there are moral triage parameters in which each patient is assessed to determine if their organ capacity will allow the patient to benefit from the limited medical resource,” she said.

“Such decisions,” Hilliard explained to LifeSiteNews, “should not be made based solely on a presumption of non-survival or even the potential for a positive COVID-19 diagnosis, or as some policies propose, based on age or disability. These are patient-specific decisions, addressing the proportionate benefit to the patient in each specific case. The patient-specific clinical information is not available in the field for the emergency responders to make such a decision.”

The do-not-resuscitate guideline had been proposed by physician leaders of the Emergency Medical Services (EMS) Regional Medical Control Systems and the State Advisory Council – in accordance with American Heart Association guidance. It was based on standards recommended by the American College of Emergency Physicians and adopted in multiple other states, the New York Department of Health explained in a statement.

The guideline was “issued April 17, 2020 at the recommendation of the Bureau of Emergency Medical Services, and reflected ‎nationally recognized minimum standards.”

“However, they don’t reflect New York’s standards and for that reason DOH Commissioner Dr. Howard Zucker has ordered them to be rescinded,” the statement explained.

Hilliard said that do-not-resuscitate orders, or those that discontinue resuscitation, “can be a moral option if they are based on informed consent of the patient or their surrogate decision maker, or if efforts become futile.”

One example would be people “in hospice programs” who “do not want to extend the natural dying process when their heart stops from a terminal disease,” the ethicist pointed out. However, “the reported and now rescinded Emergency Medical Services policy takes that decision away from the patient.”

According to the New York Department of Health, the do-not-resuscitate guideline was “necessary during the COVID-19 response to protect the health and safety of EMS providers by limiting their exposure, conserve resources, and ensure optimal use of equipment to save the greatest number of lives.”

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Hilliard countered that “not to continue those measures until the hospital assumes care and the ability of the patient to survive can be assessed, violates the provider-patient trust codified in all health professional practice acts.”

When the New York Post first reported on the DNR order, the Department of Health had insisted the new guideline had been in use “in many areas of the US as well as other locations throughout the world.”

“These changes are based on standards widely agreed upon by the physician leaders of EMS Regional Medical Control Systems across [the state of New York] and the Medical Standards Committee of the State Emergency Medical Services Advisory Council,” the New York Post was told.

Like Hilliard, paramedics and other emergency workers were not happy with state authorities.

“They’re not giving people a second chance to live anymore,’’ said Oren Barzilay, head of the city union whose members include uniformed EMTs and paramedics. “Our job is to bring patients back to life. This guideline takes that away from us.”

As reported by the New York Post, the New York City Fire Department “swiftly issued a letter Friday, … telling city emergency services workers that ‘the NYC 911 system will continue to maintain a higher level of care,’ meaning attempted revivals at scenes would continue.”

“Emergency responders are trained and skilled at resuscitation,” echoed Hilliard, the co-chair of the Catholic Medical Association’s ethics committee. “They want to save lives.”

Hilliard characterized the do-not-resuscitate guideline as “demoralizing to these heroes.”

“Determination of patient consent and treatment futility are to be determined when more clinical data is available,” she added. “Clearly, we stand in [awe] of our health care providers responding to a call to save a life when their own may be put at risk. There, too, case specific hazards must be assessed and protection provided for responders. But a general policy that abandons a patient who is contagious is not the answer.”

Prior to the controversy about the do-not-resuscitate guideline, cardiac arrest victims were already no longer taken to hospitals in New York City, due to the coronavirus pandemic and its effect on hospitals in the Big Apple.

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