Daily COVID-19 Briefing April 20, 2020
United Church of Christ – Wider Church Ministries
Humanitarian Development Team
Coronavirus (COVID-19) Daily Briefing
Barbara T. Baylor, MPH – Temporary Health Liaison
Do you have your Advance Directive completed yet?
Do you have an Advance Directive? April 16 was National Healthcare Decision Day. The goal of this day is to inspire, educate and encourage Americans to think about the importance of advance healthcare plans and to set aside time to discuss them with family members by executing advance healthcare directives.
A 2017 Kaiser Family Foundation/The Economist survey found that most people have not set down their wishes in the event of serious injury or illness – including COVID-19 – that can result in incapacitation or death, and have not named a healthcare decision maker to express their wishes for their end-of-life care.
According to a survey by The Conversation Project, a campaign to promote communication about death and dying, 92 percent of people say talking with their loved ones about end-of-life care is important, but only 32 percent have actually done so.
National Health Care Planning Day is a reminder that in the absence of an Advance Directive, medical personnel rely on family members to determine what a patient’s wishes might be. The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care.
One of the realities of COVID-19 is that people are suffering and dying alone in intensive care units. They might need ventilators or other machines to keep them alive, and they have no loved ones holding their hand, offering love and support, and helping convey their wishes to doctors.
According to Dr. Rebecca Sudore, founder of the University of California San Francisco’s Prepare for Your Care website, any advance care planning done now, even just naming a medical decision maker, can save a person, their family and friends and any clinicians so much concern and heartache later.
A COVID-19 patient’s health can deteriorate rapidly, reducing the time that physicians can discuss and decide the wishes of patients. The only means of knowing a patient’s wishes may be the Advance Directive.
While, personal Advance Directives do help ensure that patients get the care that is in concordance with their wishes, hospitals are facing another very sad consequence of COVID-19. The coronavirus has forced some doctors to weigh resuscitating a dying patient against the real danger of exposing doctors and nurses to the coronavirus.
In New York City, the U.S. epicenter of COVID-19, The Washington Post reported that some hospitals are activating policies allowing doctors to not revive dying COVID-19 patients. Hospitals have begun to implement new Do Not Resuscitate (DNR) policies for critical COVID-19 patients as masks, ventilators and other medical equipment quickly become in short supply. DNR policies are medical orders not to perform CPR on a patient if their heart stops beating, or if they stop breathing.
This is a scary trend for doctors who may have to make some judgments about who can or cannot be resuscitated. Bioethicists have weighed in on the need for hospitals to create triage committees, teams of nurses and doctors that evaluate COVID-19 cases and remove the burden of rationing care from the individual providers.
Reports emerged last week that other hospitals were also weighing changes to their DNR policies as coronavirus cases spiked around the country. Risk of exposure to COVID-19 by physicians and healthcare workers during the resuscitation process is another reason for policy changes.
In the weeks and months ahead, many more people will become seriously ill due to COVID-19. It is possible that healthcare providers will be unable to provide person-centered care if they don’t know what patients want. It is important that that health systems, insurers and community service providers reach out to all their members, especially seniors and others at risk of serious illness, to provide encouragement and support for completing Advance Directive planning documents.