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DELAWARE: CHRISTIANA CARE DOCTORS DECIDE LIFE OR DEATH~MAY OVERRULE CORONAVIRUS PATIENTS’ END OF LIFE TREATMENT WISHES

Ken L. Silverstein, M.D., MBA

Chief Physician Executive; Executive Vice President, ChristianaCare

SEE: https://christianacare.org/people/kenneth-l-silverstein-m-d/

Frederic Todd Harad, MD

Frederic Todd Harad

BY: Esteban Parra and Karl Baker, Delaware News Journal  

SEE: https://www.msn.com/en-us/health/medical/christianacare-doctors-may-overrule-coronavirus-patients-end-of-life-treatment-wishes/ar-BB12z0cT;

republished below in full unedited for informational, educational & research purposes:
As Delaware edges closer to an expected surge of coronavirus patients that could overwhelm hospitals, doctors working at the state's largest health provider have been told they do not need to abide by patients' do-not-resuscitate wishes if the treatment would be non-beneficial. 

a large brick building: U.S. News & World Report has ranked Christiana Care Health System the No. 3 hospital in the Philadelphia region and the No. 1 hospital in Delaware.© JENNIFER CORBETT/THE NEWS JOURNAL U.S. News & World Report has ranked Christiana Care Health System the No. 3 hospital in the Philadelphia region and the No. 1 hospital in Delaware.Attending physicians may overrule the objections of patients and issue the DNR in such cases, according to a ChristianaCare document obtained by Delaware Online/The News Journal dated April 3.

Hospital officials said it would be a rare instance for this to occur and families can still immediately appeal the decision.

"Consistent with the above referenced ChristianaCare policy, an attending physician is not obligated to offer or to provide CPR if resuscitative treatment would be medically non-beneficial, even at the request of a patient or legally authorized representative," according to the document.

Labeled Guidance Regarding Code Status Determination during the COVID-19 Pandemic, the document was signed by two of the hospital provider's top physicians: Dr. Kenneth Silverstein, executive vice president and chief physician executive, and Dr. F. Todd Harad, chief, vascular surgery and associate director, Center for Heart and Vascular Health.

The hospital changed the guidance because risks to doctors and nurses have increased amid the pandemic, while the likelihood of a recovery for a resuscitated patient with "severe" coronavirus symptoms is low, said John Goodill, director of Supportive and Palliative Care Education and Outreach at ChristianaCare.

When "you have progressive life-sustaining measures instituted and you're getting worse despite that, you're not going to survive," he said. "So resuscitating you when you die would not provide any benefit."

Asked if the rule change was designed to preserve ventilators and other hospital equipment, Goodill said it is not "about a scarce allocation of resources.”

Though he said the hospital system is "hoping to not get into a situation that New York is" where health care institutions are operating at overcapacity as coronavirus patients flood emergency rooms.     

“We have enough resources, right now," Goodill said. 

Before the coronavirus pandemic, an attending physician who put in place a DNR without consulting a hospital ethics committee risked a lawsuit from the patient's family, Goodill said.

With the guidance, the attendant can impose the measure with the support from the hospital as an institution, he said. Even with the change, patients or families still can appeal the decision, he added. 

"This new guideline simply puts a little more institutional support around on the side of the providers to put in place a DNR, he said, "even when the family doesn’t agree with it."

We are providing this content free as a public service to readers during the coronavirus outbreak. Please support the work we're doing by subscribing to Delaware Online.

Hospitals across the country are examining guidelines that allow doctors to override the wishes of COVID-19 patients, as they may pose a risk to staff.

R. Alta Charo, a University of Wisconsin-Madison bioethicist, told the Washington Post that while the idea of withholding treatment may be unsettling, especially in a country as wealthy as ours, it is pragmatic.

"It doesn't help anybody if our doctors and nurses are felled by this virus and not able to care for us," she said.

'WHO LIVES AND WHO DIES:' In a worst-case scenario, ethics guide choices on who gets care

According to ChristianaCare's document, the state's largest health care provider drafted its "Do Not Resuscitate / Allow Natural Death / Treatment Limitations" policy in 1993 and then updated it in 2018.

That policy is still in place.

While that policy outlines certain principles, the April 3 document provides additional guiding considerations around code status determinations during the coronavirus pandemic, which as of Monday had killed more than 22,000 Americans – 33 of them in Delaware.

The guiding considerations include the possibility that CPR would not benefit certain COVID-19 patients, particularly those with:

  • Advanced age.
  • Comorbidities, which is the simultaneous presence of two chronic diseases or conditions in a person.
  • Severe respiratory disease, such as acute respiratory distress syndrome.
  • Sepsis with multi-organ failure.
  • Progressive clinical decline despite maximal life-supportive measures.

Another guide a doctor must consider is the probability that performing CPR on patients with coronavirus will increase transmission to health care workers, threatening their well-being and reducing their availability to treat future patients. 

a man and a woman sitting in a parking lot: A man is tested for the coronavirus by healthcare workers from ChristianaCare in the parking lot of Chase Center on March 13.© Jennifer Corbett, Delaware News Journal A man is tested for the coronavirus by healthcare workers from ChristianaCare in the parking lot of Chase Center on March 13.ChristianaCare recommends another physician agree with the attending physician's do-not-resuscitate order. 

"Patient or representative assent should be sought but is not required," the document states. "The attending physician should document in the record the basis for the decision and, if applicable, the agreement of the other physician."

Physicians who decide not to offer CPR should inform the patient or their representative of the decision and the reason why and assure them that the patient will continue to receive all other forms of care.

An appeal of the do-not-resuscitate order may be initiated by asking for an expedited ethics consultant, the document said. 

Other Delaware hospitals were asked about their do-not-resuscitate guidances. Only Saint Frances responded:

"At Saint Francis Healthcare, we are committed to faithful care for our patients and their families and we provide support in making end of life choices," Ann D'Antonio, a spokeswoman for Saint Francis' parent company Trinity Health Mid-Atlantic, said in a statement. 

D'Antonio said they ask patients if they have an advance health care directive or living will, indicating their health care wishes. 

"If these documents do not exist, we hold discussions with the patients and their families to determine their wishes, including their wishes for end of life care," she said. "We continue to follow this process during the COVID-19 pandemic."

The Delaware Healthcare Association issued a statement Friday on behalf of hospitals that did not respond. The statement said they regularly communicate with colleagues in other states and are aware of the "hot spot" locations where health care providers have been forced to make difficult decisions regarding resource allocation, due to an extreme surge of COVID-19 patients that outpaces the ability to meet patient need. 

a woman in a blue shirt: A ChristianaCare healthcare worker holds swabs in her hands to be used for coronavirus testing in the parking lot of the Chase Center on March 13. Tests were free, and patients will receive their results in two to five days.© Jennifer Corbett, Delaware News Journal A ChristianaCare healthcare worker holds swabs in her hands to be used for coronavirus testing in the parking lot of the Chase Center on March 13. Tests were free, and patients will receive their results in two to five days."Delaware hospital ethics committees, along with the state, are developing a crisis standard of care framework to be implemented in the event that available resources are less than patient need in a peak demand environment," Wayne Smith, president and CEO of the Delaware Healthcare Association, said in the statement. 

The best way to ensure there are enough hospital beds, ventilators, health care providers and personal protective equipment to care for hospitalized COVID-19 patients in Delaware is for Delawareans to stay at home and practice social distancing to continue to help “flatten the curve” and slow the spread of coronavirus disease, Smith said. 

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Contact Esteban Parra at (302) 324-2299, [email protected] or Twitter @eparra3.

This article originally appeared on Delaware News Journal: ChristianaCare: Doctors may overrule coronavirus patients' end-of-life treatment wishes

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FROM: DELAWARE FAMILY POLICY COUNCIL-https://www.delawarefamilies.org/learn-as

republished below in full unedited for informational, educational & research purposes:
Assisted Suicide And COVID19
It goes without saying that our world has changed drastically in the last month or so due to the threat and fear of COVID19. Multiple areas of life are affected by not just the virus, but by how officials are choosing to handle it.
ChristianaCare has provided that 'physicians may overrule the objections of patients and issue the DNR'. In this way, they have effectively implemented euthanasia without so much as a vote from Delawareans!
This time of great vulnerability has literally been weaponized against in their greatest moment of need. Overriding a person's wishes in order to not resuscitate them is dangerous and morally wrong. It goes even farther than a person who desires to die and is state sanctioned murder!
Even though we are currently living in unprecedented times, the issues with assisted suicide have not changed. It still fails to honor the value and dignity of human life and is a dangerous policy to consider. Suicide is not a part of medical care and should not be treated as such.
Assisted Suicide Is Not Medical Care Or Treatment For Suffering! 
The work of medical professionals in providing medical care is always to help and never to harm. This means that assisted suicide would have to be of help in order to be considered a form of medical care.
Pain treatment is a legitimate part of medical care and helps to ease the suffering that individuals may experience. Legitimate pain treatment does not have to kill the patient, however, in order to kill the pain.
The leading medical associations in the nation, the American Medical Association, the American College of Physicians, the American Nurses Association, and the American Academy of Medical Ethics all stand in opposition to physician assisted suicide legislation. Medical associations in Delaware are also against supporting physician assisted suicide.
It would change the entire ethos of medical care! How could it not? Studies show that the doctors who do assist in the death of patients become calloused and are more willing to prescribe this course of action for other patients.
The legislation proposed in Delaware, HB 140, is similar to those in other states and would allow a patient with a terminal illness to choose to receive a prescription for death from their doctor. The definition given for terminal illness, however, is extremely vague. It simply states that the disease by "irreversible" or "incurable," but does not say that it is untreatable.
This means that a person with a common disease like diabetes, that is both irreversible and incurable, would be eligible to receive a prescription for death. Diabetes is not only treatable, but millions of Americans live with it everyday.
Depression is yet another illness that people suffering from would be able to use in order to be eligible for physician assisted suicide. An otherwise healthy individual would be able to kill themselves with the help of medical professionals, simply because they are suffering from depression. The only thing that separates this from suicide is that a medical professional helps in the process. It is more than just a from of suicide, however, it is state-sanctioned murder.
Where assisted suicide is legal, it is literally cheaper to die than receive actual treatment. Insurance companies are denying coverage for legitimate treatment offering assisted suicide instead. This is completely unethical and devalues the dignity of human life.
It gets worse...
Legalized assisted suicide would require physicians to LIE on a patient's death certificate so that the life insurance isn't affected.
That's right. Assisted suicide would state that the death certificate “must list the underlying terminal illness as the cause of death," when in fact, assisted suicide was the cause of death. This protects physicians--and anyone in the patient's life who would benefit financially from their death--NOT THE PATIENT.
Assisted suicide offers zero accountability.
With major room for oversight and zero accountability, assisted suicide allows for legal murder. If the patient struggled at the time of death, there would be no way of knowing. This is not healthcare, this is murder sanctioned by the state!
What happens if they change their mind and decide not to take the pills? Once prescribed, the deadly drugs are on the loose and can be taken by someone else ... a child even!
Assisted suicide has major possibilities to cause much more harm than the supporters argue it will help.  We have to stop this from harming innocent Delawareans!
“Every time they ask a physician to prognosticate on life expectancy... it's usually wrong."

-Dr. Bescia, Kidney Disease Expert and
Co-inventor of Cimino-Brescia Fistula Hemodialysis
Do you have a story to share about a wrong diagnosis or outliving a terminal diagnosis? We need to hear your story! Please email [email protected] if you are willing to share your story with us.
 

BIDEN THE UNREPENTANT PLAGIARIZER/LIAR: RESURFACED VIDEO SHOULD DESTROY HIS CAMPAIGN

This is BAD for Joe biden. If the media actually covered the race fairly, Joe would have probably dropped out by now. Joe Biden's past is BRUTAL. —

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WHY NEW AGE & CHRISTIANITY CAN’T BLEND

Doreen Virtue tried to blend new age with Christianity for decades, and the results were disastrous as she explains in this video why they are polar opposites that can never blend. Doreen discusses yoga, the enneagram, essential oil blends, eastern meditation, and crystals. She warns parents about new age marketing toward children, and warns Christians about new age infiltrating into the Church.

This video originally aired on Engage Truth at https://www.youtube.com/channel/UCTjC... and on Engage Apologetics on Facebook.

Doreen's blog on the topic is at: https://doreenvirtue.com/2019/08/26/1...

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Please also visit her on social media at:

Instagram.com/Doreen Virtue

Facebook.com/DoreenVirtueForJesus

Parler: DoreenVirtue