Article Summary
Ethical decision-making is an inevitable competence for every health care professional that provides care for people daily. The ability to critically assess the factors and incorporate ethical principles and values enables the professionals to make moral decisions driven by reasonable prioritization of beneficial solutions. The article by Sultan et al. (2021) explores the ethics behind the categorization of patients in the times of the COVID-19 pandemic and the application of the order of “do-not-resuscitate” (DNR) for a particular group of patients. In addition, the study provides an overview of the health care resource deficiency during the pandemic and the strain the scarcity of medications, beds, equipment, and labor force imposes on the ability to serve all patients.
The authors of the article argue that DNR is a justifiable measure that allows for differentiating patients on the basis of the objective judgment concerning the futility of treatment in the light of an overwhelmingly high number of patients in critical care. In particular, DNR might apply for “terminally ill patients for which further medical intervention is considered futile, when the quality of life is deemed poor, or who are expected to be permanently dependent on ventilators” (Sultan et al., 2021, pp. 1-2). The problem is analyzed against the major ethical principles of health care, and probable solutions, including triage, are justified.
Ethical Dilemma Description
The ethical dilemma at hand concerns whether health care professionals should apply DNR to certain groups of patients depending on their age or health conditions under the circumstances of resource scarcity. The essence of the dilemma is that such a consideration of DNR contradicts the provisions of the Hippocratic Oath, which necessitates that “every medical physician swears to “apply, for the benefit of the sick, all measures [that] are required” (Sultan et al., 2021, p. 3). Therefore, a failure to provide a timely life-saving measure for all patients might be considered a violation of patient rights.
Ethical Dilemma Solution
The solution that the scholars provide in their article is based on the basis of measuring the benefits for the greater good of the population at large since COVID-19 has far-reaching implications on a societal level. Indeed, while under normal conditions, physicians are encouraged to make DNR-related decisions based on precise consideration of a particular case, COVID-19 imposes additional complications (Fan & Hsieh, 2020). Therefore, it is considered ethical to apply DNR to patients after triage. Furthermore, the decisions concerning DNR should be made upon considering four objective indicators, namely “futility of treatment, poor quality of life, patient refusal, and cost” (Sultan et al., 2021, p. 4). Therefore, unilateral DNR should be applied based on any of these four elements to meet the requirements of a societal benefit that prevails over self-benefit under the circumstances imposed by COVID-19.
Application of a Decision-Making Model
When resolving the discussed ethical dilemma, one should use a multi-step decision-making model that would allow for justifying a well-balanced decision incorporating the complexity of factors during the pandemic. In particular, as suggested by Fremgen (2019), the Seven Step Decision Model might be applied to ensure accuracy. Within this framework, the initial facts of the situation should be clarified first. Secondly, a specific ethical issue should be defined; thirdly, significant principles and rules should be identified; fourthly, the alternatives should be specified. Fifthly, values and alternatives are to be compared; sixthly, the consequences must be assessed; and finally, a decision should be made and double-checked (Fremgen, 2019). Since the lives of many people are at stake when making a decision about a DNR order, this detailed model will allow for making an ethically valid decision.
References
Fan, S. Y., & Hsieh, J. G. (2020). The experience of do-not-resuscitate orders and end-of-life care discussions among physicians. International Journal of Environmental Research and Public Health, 17(18), 1-10.
Fremgen, B. F. (2019). Medical law and ethics (6th ed.). Pearson.
Sultan, H., Mansour, R., Shamieh, O., Al-Tabba, A., & Al-Hussaini, M. (2021). DNR and COVID-19: The Ethical dilemma and suggested solutions. Frontiers in Public Health, 9, 1-7.
