OPINION

Allow COVID-19 Patients the Dignity of Not Dying Alone

By Gail Lennstrom, originally published in the Times Union April 2, 2020

My greatest fear is not of dying. It’s of dying alone, not being able to breathe and wondering when the end will come. My fear is now amplified as hospitals begin making difficult but necessary decisions about who will get the only available ventilator and who will be left to die. I am 73 years old and not a good candidate for surviving COVID-19 if I’m infected.

Despite White House Coronavirus Response Team Coordinator Deborah Birx’s claim that hospitals in the United States will not need systemwide DNR (do not resuscitate) orders for those who are triaged to not receive intensive care, global experience with this novel virus suggests otherwise. In Italy and Spain, health care systems have been collapsing under the weight of COVID-19. Patients who arrive in acute respiratory distress and are deemed unlikely to survive are being put to the side and may receive no care at all.

Not only are ventilators in short supply, it’s estimated that 10 percent to 15 percent of confirmed cases in Italy and Spain are health care workers. They are removed from the workforce, and some have died. In the United States, we already have reports of nurses and physicians being infected, isolated and dying. Hospitals may not have the staff to be with those who are dying.

My greatest fear is not of dying. It’s of dying alone, not being able to breathe and wondering when the end will come. My fear is now amplified as hospitals begin making difficult but necessary decisions about who will get the only available ventilator and who will be left to die. I am 73 years old and not a good candidate for surviving COVID-19 if I’m infected.

Despite White House Coronavirus Response Team Coordinator Deborah Birx’s claim that hospitals in the United States will not need systemwide DNR (do not resuscitate) orders for those who are triaged to not receive intensive care, global experience with this novel virus suggests otherwise. In Italy and Spain, health care systems have been collapsing under the weight of COVID-19. Patients who arrive in acute respiratory distress and are deemed unlikely to survive are being put to the side and may receive no care at all.

Not only are ventilators in short supply, it’s estimated that 10 percent to 15 percent of confirmed cases in Italy and Spain are health care workers. They are removed from the workforce, and some have died. In the United States, we already have reports of nurses and physicians being infected, isolated and dying. Hospitals may not have the staff to be with those who are dying.

I want a death with peace, compassion, dignity and assisted support. I want to be connected to my family — at least virtually by an iPad, since some hospitals are not allowing family to be with COVID-19 patients, even those who are dying. All hospitals should have protocols for administering morphine to ease the difficulty of breathing regardless of whether it hastens death. Alternatives for a peaceful death with dignity need to be discussed with people who may be panicked and scared. This includes creating DNR orders to support their final transition and avoid futile and painful interventions.

Triage and testing are critical in determining needs. There have been initiatives in China and other countries to create levels of care and support centers where those who test positive can be together and have supportive interactions as they are able and desire. They are already infected, so the spread among infected patients shouldn’t be a barrier to such interaction. Large centers can be easily converted for such use as demonstrated during hurricanes and other natural disasters where portions of the population are displaced.

In this triage model, acute patients will continue to be cared for in hospitals and ICUs and receive needed support. The level I’m proposing for patients who are seriously ill, but not candidates for supportive resources, requires urgently expanded hospice services for patients who are being left to die. Such spaces might be at a hospital conference room, vacant dormitory or hotel. And if we can identify those who now have the antibodies to the virus through serological testing that is now being used in New York City, we could have people able to care for patients as they die.

The hospitals cannot address this alone. Hospices know this work. I urge hospices and palliative care services to immediately partner with hospitals on developing creative approaches to ensure that we are not abandoning those who will not survive this deadly illness. Gov. Andrew Cuomo can call for such partnerships to assure that New York’s response to COVID-19 is humane for all who are affected.

Gail Lennstrom of Margaretville is a retired physical therapist and former hospice volunteer. She wrote this in collaboration with Diana Mason, a nurse and professor at the Center for Health Policy and Media Engagement, George Washington University School of Nursing.