Many ethical and legal issues are arising as the number of COVID-19 infected patients is increasing
Healthcare workers have to make difficult decisions to prioritize care, the use of pieces of equipment, and medicines. Some groups of populations’ e.g. elderly, people with physical or mental disabilities, people with multiple medical problems may be excluded from getting proper treatment.
Hospitals and state officials are struggling to make policies. If infected patient codes, is it worth to resuscitate him/her or let him die? Resuscitation involves many things that generate aerosols putting caretakers at a very high risk of being infected. It also involves the use of large quantities of personal protective equipment like masks, gowns, caps, gloves, respirators, etc. Supply of these is scarce, so is it worth saving these supplies for young patients and for people whose life expectancy and functional status are expected to be high. Hospitals do not have enough filters to protect the ventilators from being infected. If a ventilator becomes infected then it cannot be used for another patient. Many care facilities are deciding not to do aerosol-generating procedures e.g. endoscopy, intubation, bronchoscopy, etc. on infected patients even if patients die because of delayed or missed diagnosis. Many healthcare team members are saying that there is no emergency in pandemics.
If an infected patient codes, it takes longer to get to him/her and provide care as wearing personal protective equipment takes time. By the time, the team is all dressed and ready, the patient most likely is dead, and then it becomes like resuscitating a dead patient. Some hospitals are using a universal do not resuscitate policy. Under this policy COVID-19, infected patients are not resuscitated. These people die alone with no family and caretaker around. They do not even receive palliative care. There are no visiting hours now, so no family members can come and visit them.
It is a very hard decision families have to make for their loved ones. Hospitals with infected cases are becoming carriers of virus. Virus stays on many surfaces and in air for many hours. Health care team and other non infected patients are at increased risk of getting infection while inside the hospital.
Bharti Raizada