Advance Directives and COVID-19

dementia advance directiveIn a very unsettling development in the COVID-19 pandemic, the Washington Post has an article in its March 25, 2020 edition that reports that some hospital systems in the United States are considering imposing Do Not Resuscitate (DNR) orders on all patients who are admitted with the viral infection.

The implications of this for all of us are worth noting and talking about. If we have advance directives – and we should – and we want all live-saving measures used, including resuscitation, if we are actively dying, the new policy that some hospital systems (in North Carolina, Illinois, and the District of Columbia, so far) are strongly considering will go against our legal and personal wishes.

While I have a DNR in my advance directive, that is my choice and it was designed as a legally-binding (meaning that healthcare and emergency services professionals must honor it and let my last breath be my last breath) choice, this potential new hospital policy of forcing DNRs on all COVID-19 patients who are admitted to their hospitals puts the legality of all advance directives in jeopardy. It also raises grave ethical concerns.

On another one of my websites, I talk quite a bit about how much of our modern society reflects the society that George Orwell wrote about in his prescient 1948 novel 1984. (For the record, I reread this book at least once a year. I’ve never seen any of the movies, and don’t plan to. The book, in this case, is the thing.)

When I can stomach five minutes of the national news and many top government officials babbling absolute lies and nonsense that are so obvious in the cold, hard light of facts and evidence, I can’t help feeling like Winston Smith listening to Big Brother.

Smith counters the lies in his head (even though it’s a dangerous thing to do) with his knowledge of the truth and with critical thinking. It seems, though, that everyone else just accepts the garbage and junk at face value – and believes it.

This policy that some hospital systems are considering is another step into the dystopian society that 1984 chronicles. The law no longer applies. Our personal wishes for our lives – and our deaths – don’t matter. Someone else will make those decisions for us, whether they are what we want or not.

I’m not surprised from a legal aspect because authoritarian government is where the United States has been headed for some. However, the ethical implications are more concerning.

In the past few days, there have been statements like that of Texas Lt. Governor Dan Patrick that, in essence, said that elderly people would be willing to die of COVID-19 if it meant saving the American economy. This “they’re old anyway, so let ’em die” attitude is more prevalent among the current American president’s base of supporters, including the president himself, than most people might think.

The forced DNR policies that some hospital systems are considering traverse this same path. The only difference is that age is not a consideration, just infection, so whether a 20-month-old baby has COVID-19 or a 90-year-old man (men seem to be more prone to COVID-19 infection than women, although scientists don’t yet know why) has it, their families will be forced to agree to DNRs for them, regardless of what advance directives they already have in place.

Ethically, this is wrong. Ethically, it’s not dissimilar from what happened to all the victims of the massive and horrific genocide (the Jewish people were the largest group, but other ethnic groups in and around Germany were included as well) that occurred under Adolf Hitler in Nazi Germany from 1933 to 1945 (the full onslaught of massive killings didn’t begin until 1938, but it had been underway on a smaller scale since Hitler had come to power).

Think about this, no matter whether you have a DNR or don’t have a DNR in your advance directive. This is just the beginning. It should be a somber warning to us all of where we are headed.

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