Ventilator treatment for COVID-19 leads to questions of end-of-life

Now is the time to talk to your friends and family about your prospects of survival should you become deathly ill. But if you’re like me, you’d rather not start the conversation.

image: The Conversation

If you are unfortunate enough to catch the new coronavirus and are placed on a ventilator, the odds are two-to-one that you will die. And if you survive, your quality of life could be seriously compromised.

The numbers are still coming in, but they don’t look good. One review conducted in China said that 86 percent of COVID-19 patients put on ventilators eventually died. In the UK, about two-thirds of ventilated patients died.

From an optimistic perspective, you have a chance of living so why not take it?

In the most serious cases, COVID-19 takes over the respiratory system and leads to pneumonia. Your lungs fill with fluid and you can no longer capture oxygen; you begin to suffocate and are left literally gasping for air.

A ventilator seems like the obvious choice but it’s extremely invasive. You are sedated and muscle-paralyzing drugs are given -the procedure is so aggressive that you would not tolerate it otherwise. A 10-inch tube is inserted into your lungs with the hope is that the oxygen will prevent you from suffocating to death before the body’s immune system is able to rally, overwhelm the virus and return you to health. That’s the hope.

Kathryn Dreger, an internist and professor of medicine at Georgetown University, describes a common result:

“The amount of sedation needed for Covid-19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.”

Given that prospect, you will have to make the agonizing decision to ventilate or not. And you will have to decide at a time when you are least able to do so, when you are very sick and perhaps not thinking clearly.

Your doctor can help you decide but it’s not a purely medical decision. These are highly personal decisions affecting your future quality of life.

As difficult as it may be, you should give advance directions regarding invasive treatments.

As I watched my wife die of breast cancer seven years ago, the need for such directions became painfully clear. She had signed a “do not resuscitate (DNR)” order. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if her breathing stopped or her heart stopped beating. She died without any of those interventions.

When I talked to my doctor shortly after her death about a DNR order for me, he was concerned; worried about my apparent preoccupation with imminent death when I seemed perfectly healthy.

The best chance that a DNR will be honoured is if you have talked to your doctor and family. But kids have trouble dealing with their own mortality, let alone yours.

In our culture where talk of death ends a conversation, it’s easier not to start the conversation.

I would not consider a life hooked up to tubes, or bed-ridden with recurrent infections, worth living but I procrastinate in getting a DNR order.

One day when I’m least capable making the decision, I’ll probably regret my procrastination.

 

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