This essay argues that DNR (do not resuscitate) status should not be considered as a factor in decisions to allocate scarce ventilators during a public health emergency.
The authors note that some existing and proposed public health emergency resource allocation guidelines include DNR status as an exclusionary criteria for allocations of ventilators or other critical care resources. The authors explain that the committee that drafted New York’s 2015 guidelines (which included both authors) considered and unanimously rejected inclusion of DNR status among exclusionary criteria. In contrast, the authors cite provisions from regional triage plans from groups Texas and South Dakota that explicitly include DNR status as excluding a patient from hospital admission or transfer.
The authors do not object to honoring a patient’s choice to refuse ventilator care or even to universal DNR status for COVID-19 patients if clinically necessary and appropriately implemented. However, they argue that DNR status DNR status indicates only a patient’s medical treatment preferences specifically with respect to CPR. DNR status has no relationship to a patient’s likelihood of surviving COVID-19 with ventilator therapy, nor does it reflect a patient’s preferences regarding ventilator care.