Now is the time to ensure patients do not receive care they would not want if they become too severely ill to make their own decisions.
The COVID-19 pandemic is raising important ethical issues about the potential need to ration health care due to scarce resources and crisis capacity.
But even if a health system has sufficient capacity to provide care during the pandemic, clinicians still need to work hard to ensure that a patient’s wishes are addressed in the event of acute life-threatening illness. This is especially true for patients with chronic, life-limiting disease.
“Clinicians should ensure patients receive the care they want, aligning the care that is delivered with patients’ values and goals,” writes Dr. Randall Curtis in JAMA. “Patients most likely to develop severe illness will be older and have greater burden of chronic illness—exactly those who may wish to forgo prolonged life support and who may find their quality of life unacceptable after prolonged life support.”
Curtis provides 3 reasons why advance care planning must take high priority, especially now:
- Clinicians should always strive to avoid intensive life-sustaining treatments when unwanted by patients.
- Avoiding nonbeneficial or unwanted high-intensity care becomes especially important in times of stress on health care capacity.
- Provision of nonbeneficial or unwanted high-intensity care may put other patients, family members, and health care workers at higher risk for transmission of severe acute respiratory issues associated with of COVID-19.
Advance care planning discussions with patients should include both primary care and specialty clinicians like cardiologists, pulmonologists, nephrologists, oncologists, and geriatricians, writes Curtis. Depending on state regulations, patients with chronic life-limiting illness should be offered the option to complete a physician order for life-sustaining treatments form, especially if they would not want to receive cardiopulmonary resuscitation or mechanical ventilation.
“Now is the time to implement advance care planning to ensure patients do not receive care they would not want if they become too severely ill to make their own decisions,” writes Curtis.