Health Care Providers’ Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran

Mirhosseini, Seyedmohammad; Aghayan, Seyed Shahrokh; Basirinezhad, Mohammad Hasan; Ebrahimi, Hossein

doi:10.1177/00302228211057992

Cited by 3 publications

(2 citation statements)

References 27 publications

(28 reference statements)

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“…Nurses can especially be helpful to patients in this difficult decision-making process [185,186], and having DNR orders can influence the aggressiveness of nursing care attitudes [187]. Regarding the COVID-19 pandemic, one study in Iran found that healthcare providers' attitude towards DNR implementation in patients with COVID-19 was positive despite a legal ban on DNR implementation in Iran [188].…”

Section: Values What Is Each Team Member's Own Values Towards End-of-...mentioning

confidence: 99%

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Kalapatapu

2023

Curr Res Psychol Behav Sc

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Management of patients who have end-of-life orders may be complicated by the presence of an involuntary psychiatric hold for suicidality or grave disability. Decision-making factors that have been previously described include principles of medical ethics, laws and legal precedent, and examination of the motivations for end-of-life orders. However, management remains difficult, especially in time-limited settings such as the emergency room due to the wide-ranging existence of patient factors, individual ethics, and policies at governmental and hospital levels. We examined existing literature on the topic and created a structured conceptual model of key considerations for end-of-life issues during involuntary psychiatric holds in an emergency room setting, grouped into patient, involuntary psychiatric hold, system, and provider factors. These encompass the range of factors most likely to guide decision making on individual cases that emergency clinicians will face.

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Section: Values What Is Each Team Member's Own Values Towards End-of-...mentioning

confidence: 99%

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Kalapatapu

2023

Curr Res Psychol Behav Sc

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“…During the COVID-19 pandemic, increased patient admissions and staff risk performing CPR without adequate personal protective equipment contributed to public concern that clinicians would make unilateral decisions to not offer CPR against patient preferences (14–16). There was also concern that use of UDNR orders may exacerbate racial and ethnic disparities in patient outcomes already existing during the pandemic (17, 18).…”

mentioning

confidence: 99%

Disparities in Unilateral Do Not Resuscitate Order Use During the COVID-19 Pandemic*

Piscitello

Tyker

Schenker

et al. 2023

Critical Care Medicine

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OBJECTIVES: A unilateral do-not-resuscitate (UDNR) order is a do-not-resuscitate order placed using clinician judgment which does not require consent from a patient or surrogate. This study assessed how UDNR orders were used during the COVID-19 pandemic. DESIGN: We analyzed a retrospective cross-sectional study of UDNR use at two academic medical centers between April 2020 and April 2021. SETTING: Two academic medical centers in the Chicago metropolitan area. PATIENTS: Patients admitted to an ICU between April 2020 and April 2021 who received vasopressor or inotropic medications to select for patients with high severity of illness. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 1,473 patients meeting inclusion criteria were 53% male, median age 64 (interquartile range, 54–73), and 38% died during admission or were discharged to hospice. Clinicians placed do not resuscitate orders for 41% of patients (n = 604/1,473) and UDNR orders for 3% of patients (n = 51/1,473). The absolute rate of UDNR orders was higher for patients who were primary Spanish speaking (10% Spanish vs 3% English; p ≤ 0.0001), were Hispanic or Latinx (7% Hispanic/Latinx vs 3% Black vs 2% White; p = 0.003), positive for COVID-19 (9% vs 3%; p ≤ 0.0001), or were intubated (5% vs 1%; p = 0.001). In the base multivariable logistic regression model including age, race/ethnicity, primary language spoken, and hospital location, Black race (adjusted odds ratio [aOR], 2.5; 95% CI, 1.3–4.9) and primary Spanish language (aOR, 4.4; 95% CI, 2.1–9.4) had higher odds of UDNR. After adjusting the base model for severity of illness, primary Spanish language remained associated with higher odds of UDNR order (aOR, 2.8; 95% CI, 1.7–4.7). CONCLUSIONS: In this multihospital study, UDNR orders were used more often for primary Spanish-speaking patients during the COVID-19 pandemic, which may be related to communication barriers Spanish-speaking patients and families experience. Further study is needed to assess UDNR use across hospitals and enact interventions to improve potential disparities.

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Nobody Likes the Forgotten Guardians of the Departed: A Critical Ethnographic Study on Social Isolation of Ghassals

Salimi,

Ruhani

2023

Omega (Westport)

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In Islam, the ritual of burial including washing, shrouding and burying the dead body (Ghusl/Kafan/Dafan) has always been problematic. Burial in Iran has always been a well-ordered custom and there have always been specific people for this ritual (Ghassals). Due to dealing with the dead, their lives are always the focus of social discussions. Drawn on Carspecken’s (1996) five-stage approach, this research examined the social isolation of Ghassals in Yazd province, Iran. The data were obtained through participant observation (first covert then overt) and in-depth interviews with six Ghassals in Yazd. The main themes extracted included stigma and isolation, the experience of hegemonic violence, problematic companionship/not companionship, forced choice, job dissatisfaction, and social discouragement. Our findings indicate an undesirable social status for the Ghassals who are often unwelcomed by the society and in some cases even by the family. These behaviors ultimately lead to social isolation and depression among Ghassals.

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Health Care Providers’ Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran

Cited by 3 publications

References 27 publications

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Disparities in Unilateral Do Not Resuscitate Order Use During the COVID-19 Pandemic*

Nobody Likes the Forgotten Guardians of the Departed: A Critical Ethnographic Study on Social Isolation of Ghassals

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