A leading medical ethicist has come forward recently, in response to the growing Ebola crisis in the United States, as well as in other countries. He is raising a very difficult issue that doctors need to address sooner rather than later. He believes that Cardiopulmonary Resuscitation should be withheld from patients suffering from the disease. Dr. Joseph J. Fins is urging a national debate on this, before it is too late. When a patient is being treated in the hospital, and their heart stops beating, medical staff have seconds to leap to respond. This is because the brain, and other vital organs have mere minutes that they can survive without adequate oxygenation. The brain can only survive for about 6 minutes without oxygen. After that, the chances of irreversible damage is highly likely. If the patient DOES survive, it s likely that the quality of life will be that of a comatose patient, or one with severe brain damage resulting, in no real life at all.
The problem is that a whole team of medical staff would have to don all the protective equipment necessary to perform life saving treatments, which would take minutes away from the already few that they have when a patient codes. By the time they could even start, it could already be too late. If they rush in, like the normal code procedures call for, they would be putting themselves in a severely high risk of contracting the disease themselves.
Dr. Fins is pushing for a blanket DNR (do not resuscitate) order for patients with the disease. But, it is not just the patient’s outcome he is concerned with. He is focusing more on the safety of health care workers and their exposure. If a patient with Ebola has gotten to this stage in the disease, where the heart is shutting down, he believes that it is an unnecessary risk for doctors and hospital staff to try to bring the patient back. The nation is already dealing with treating medical staff that have contracted the disease while caring for an infected patient.
Lawrence K. Altman, “Ethicist Calls CPR Too Risky in Ebola” New York Times, October 20, 2014.
Student Researcher: Heather Gerber, Indian River State College
Faculty Evaluator: Elliot D. Cohen, Ph.D., Indian River State College
End-of-life care has been an ongoing, ever-changing issue in the medical field, for as long as people have been practicing medicine. There has been an ethical debate, for just as long, about who has the right to deny a patient treatment that could save his or her life. Doctors struggle with these decisions every day. If the patient does not have a DNR, and goes into cardiac arrest, medical teams are obligated to treat the patient. They apply the method of do “everything possible” to save a patient. But where do we draw the line? Health care workers have a sworn duty to treat their patients, but they also have to be able to do so safely. What good will come of more and more doctors and nurses unnecessarily risking their lives for a patient who is at the end stages of a ravaging disease? And who makes the call to withhold CPR? This issue needs to be addressed before the incidents occur, because the patient’s bedside is not the place to have this debate. Also, health care workers need to be protected from the legal implications of denying care, if the patient dies as a result.
Other ethicists are coming forward, supporting the idea that there needs to be protocol in place to protect medical workers. Laurence McCullough, a clinical ethicist at Baylor College of Medicine, called the statement, “very well reasoned”; and he said it “reminds us that there are justified limits on the risk to health and life that health care professionals are expected to take in the care of patients.” We need to think about the greater good in this situation. Medical workers risk their lives everyday, as it is, but the line needs to be drawn. As the disease continues to spread, we are going to see more and more health care workers that are unwilling to put themselves in this severe, high risk situation that a patient with Ebola presents. This issue is being raised to protect medical staff physically from the disease, and also from the implications of withholding care from a patient. This issue is at the heart of ethics in medicine. Do we attempt to save patients who may be beyond saving? Or do we protect our health care workers from unnecessary risks, so that they can continue practicing medicine safely. I believe we will be seeing this story emerge very quickly, as the number of Ebola cases continue to increase, and this issue will be up for debate nationally, as it should be, and soon.