I have written elsewhere about how the Covid-19 pandemic has resulted in dangerous and unethical responses like ventilator rationing, unilateral DNRs, and some states ordering nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals.
But the Covid-19 crisis has also spawned new ideas such as the American Clinicians Academy On Medical Aid in Dying’s policy recommendations for Covid-19 advance directives aimed at refusing potentially life-saving treatment.
Compassion & Choices, formerly known as the Hemlock Society, promotes assisted suicide, voluntary stopping of eating and drinking (VSED) and terminal sedation. During the pandemic it has created a Covid-19 tool kit with a special Covid-19 addendum to add to an existing advance directive to refuse care if a person gets Covid-19. The addendum even contains the question:
“Do you want your healthcare proxy to have the ability to override any of these orders if he or she believes you have a reasonable chance of living a life consistent with your values and priorities based on the information provided by the doctor? Or, do you want these orders followed no matter what?” (Emphasis added)
“In the event of shortages during the period of a declared emergency related to Covid-19, and in order to direct resources to others, I am willing to receive palliative care instead of: Critical medical equipment (ventilator, ECMO, etc.), Medication (other than palliative), Placement in a hospital care unit that provides critical care.” (Emphasis added)
Even more disturbing, the National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the “ethical allocation of scarce medical resources during a disaster” that:
“provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life-saving care during an emergency event or disaster and which ones will not. With the event of the Covid-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care”. (Emphasis added)
The National Hospice and Palliative Care Organization (NHPCO), “founded in 1978, is the nation’s largest membership organization for providers and professionals who care for people affected by serious and life-limiting illness”. NHPCO states that it “represents the interests of its members and the general public with legislative advocacy that helps to enhance and expand access to carethat addresses holistic health and the well-being of communities.” (Emphasis added)
Not surprisingly, the NHPCO has supported the problematic Palliative Care and Hospice Education and Training Act, currently still in the US Congress awaiting passage.
The Covid-19 pandemic is terrifying for many people. But we must realize that just like any other serious or terminal illness, we must act responsibly and ethically in caring for people with the disease.
While medical treatment that is medically futile or unduly burdensome to the person can be ethically refused or withdrawn, refusing or removing ordinary medical treatment or deliberately over-sedating a person in order to cause or hasten death is unethical. This is true even when we think it may help another person get care.
We need to know the difference, especially when it comes to making out “living wills” or other advance directives.
Ironically, the Covid-19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of respecting every life to the dangerous notion that some lives are expendable — including our own.