Be specific when creating living will
Dear Dr. Roach: At what point in COVID-19 does a person’s do not resuscitate order become an issue? When does treatment become an “exceptional or extraordinary” effort? It would seem that organ transplants, if not coma/ prolonged artificial ventilation would qualify. I have never seen anything on this issue.
R.S.
Answer: A do not resuscitate order is not one-sizefits-all. Ideally, a person considers carefully what they want and, with the help of an expert, writes up a document (called a “living will”) to go over how that relates to a variety of circumstances.
Since it’s impossible to consider every possible situation, it is also wise to discuss your feelings with a designated person who becomes a patient’s health care proxy through a document called a “durable power of attorney for health care.” This person can then help the team taking care of the patient in situations not specifically addressed by the living will.
In the case of COVID-19, many people who have contracted the infection have preexisting health conditions that have made them vulnerable, and have a living will indicating they don’t want “exceptional or extraordinary” care.
However, many people with COVID-19 infection are healthy, young people. In these cases, we usually try absolutely everything we can, since some people, even among the very most ill, will pull through.
One of the very last resorts we have is extracorporeal membrane oxygenation (ECMO), which is a machine that essentially takes over the lungs’ job of oxygenating blood. People placed on ECMO for severe COVID-19 infection still have a 50% risk of in-hospital death.
Another last-ditch treatment is lung transplantation: This also saves some lives, but is a precious resource that many will not qualify for.
Someone with COVID-19 infection and a typical do not resuscitate order would still be treated with the best medications and support we have, but would usually be allowed to pass away rather than be placed on a ventilator, and would certainly not get the truly heroic measures, such as ECMO or lung transplant.