International

Switzerland pressures elderly COVID-19 patients to sign DNRs

COVID, Switzerland

As the world braces for winter surges of the COVID-19 pandemic, Switzerland is taking action. However, rather than announcing plans to save as many lives as possible, doctors are allegedly asking elderly patients, as well as those with pre-existing illnesses or conditions, to sign do-not-resuscitate (DNR) orders.

According to The Sun, Switzerland has seen a skyrocketing number of COVID-19 cases in recent weeks, with nearly 10,000 cases diagnosed daily. The Swiss Society for Intensive Care Medicine (SGI) reacted by asking for the “especially imperiled” — such as the elderly or those with heart conditions — to sign DNR orders. “This will support your own relatives, but also the teams in the ICUs, as they make decisions so the treatment can be done in the best possible manner according to the individual patient wishes,” the SGI said in a statement.

Thierry Fumeaux, SGI president, said the goal was not to pressure people, or to ensure that beds remain available as infections increase, but merely to tell them to be “responsible.”

“This is even more important in a time when vulnerable people are at high risk of having an infection, at high risk of being admitted to an ICU, and at high risk of dying,” Fumeaux said. “This is not a call for sacrifice. It’s just a call to take responsibility for their autonomy.”

Interestingly, the SGI is not bothering to ask young and healthy people, or those without pre-existing conditions, to sign advance DNRs — only those considered at “higher risk” due to age or health conditions. By putting less effort into treating an elderly or disabled patient, doctors could instead divert resources into saving those who are younger or more able-bodied.

Earlier this year, at the beginning of the pandemic, several American hospitals had made similar — yet more disturbing — announcements. Multiple hospitals across the country had said they were considering giving DNRs to patients without their prior consent, or that of their families, arguing that resuscitations can put hospital staff in danger of catching the virus themselves. Yet other doctors have spoken out against these measures, saying they aren’t necessary to keep anyone safe or to provide good medical care.

READ: Pressured to sign DNRs during COVID-19, persons with disabilities are twice as likely to die

“From a safety perspective you can make the argument that the safest thing is to do nothing,” Bruno Petinaux, chief medical officer for George Washington University Hospital in Washington, D.C., said in March. “I don’t believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely.” Instead, Peninaux and his colleagues draped plastic sheeting over COVID patients before beginning resuscitation measures. Patients are intubated, meaning they cannot suffocate, and the plastic sheeting minimizes the risk of infection to hospital staff.

In the Netherlands, doctors also previously said they might consider simply not treating elderly patients at all during the pandemic. Dr. Frits Rosendaal, head of clinical epidemiology at the Leiden University Medical Center and a member of the Royal Dutch Academy of Sciences and Art, said senior citizens are more respected and cherished in countries like Spain and Italy than they are in the Netherlands. “In Italy, the capacity of ICUs is managed very differently,” he said. “They admit people that we would not include because they are too old. The elderly have a very different position in the Italian culture.”

Yet even an Italian newspaper published a report alleging that elderly patients are being asked if they want to be ventilated, and kept alive, or if doctors can just let them die — even if the patients hadn’t been diagnosed with COVID-19.

The COVID-19 pandemic is unquestionably changing the way doctors across the world practice medicine. But normalizing the idea of allowing people to die simply because they are elderly, or disabled, sets a disturbing standard for determining whose lives are “worth saving,” and whose are not.

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