How is COVID-19 changing the ways doctors make end-of-life decisions?

Area of Science:

• Medical Ethics
• Palliative Care
• Health Policy

Background:

• The COVID-19 pandemic significantly impacted healthcare systems globally.
• End-of-life care decisions, including Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR), faced new challenges.
• Clinicians' perspectives on treatment escalation and end-of-life options were potentially affected.

Purpose of the Study:

• To investigate the pandemic's influence on doctors' end-of-life decision-making processes.
• To assess changes in the application of DNACPR orders.
• To evaluate shifts in treatment escalation and palliative care thresholds, and views on euthanasia.

Main Methods:

• An online survey was distributed to doctors across all levels and specialties within the NHS.
• Data collection occurred between May and August 2021, a period of lower COVID-19 hospital cases and normalized resource pressures.
• 231 doctors completed the survey, providing insights into their experiences during the pandemic.

Main Results:

• Over 50% of doctors reported increased DNACPR orders compared to pre-pandemic levels, citing patient age, frailty, and resource limitations.
• A notable minority of clinicians raised their threshold for intensive care unit (ITU) escalation and lowered their threshold for palliative care.
• The pandemic did not significantly alter doctors' views on the legalization of euthanasia or physician-assisted suicide.

Conclusions:

• The COVID-19 pandemic has induced lasting changes in how doctors approach end-of-life decision-making.
• These modifications in DNACPR, treatment escalation, and palliative care practices persist even as pandemic-related hospitalizations decrease.
• Clinician perspectives on the ethics of euthanasia and physician-assisted suicide were not significantly impacted by the pandemic.