The authors of this paper argue that advance care planning and discussing goals of care are of heightened importance for patients with chronic, life-limiting disease, due to COVID-19 for three reasons:
1) It is an ethical imperative to avoid providing unwanted life-sustaining interventions; 2) avoiding unwanted or non-beneficial treatments will alleviate stress on the health care system; and 3) providing unwanted or non-beneficial treatment puts others at risk due to the potential transmission of COVID-19. For all these reasons, clinicians should prioritize proactive advance care planning. The authors provide guidance on the logistics of engaging in goals of care discussions, with specific discussion about code status or the use of CPR and advanced cardiac life support (ACLS), and the use of do-not-resuscitate (DNR) orders. The implementation of informed assent, in which the provider asks the patient or family member to allow the clinician to assume responsibility for the care decisions, “may be useful for patients in whom CPR is exceedingly unlikely to allow a successful return to a quality of life they would find acceptable.” The Informed Assent Framework, is implemented when family members allow the clinician to make decisions as they are unable or unwilling got accept responsibility themselves, because of the psychological burden the decision places on them.
Curtis, J. R., Kross, E. K., & Stapleton, R. D. (2020). The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19). Jama.