ABSTRACT
AIMS & OBJECTIVES: The Tsunami of COVID-19 ethical guidance has led clinicians to feel as if they were drinking water from a hosepipe on full blast! However, to be useful, ethics should be a practical, not a guideline discipline - we describe the support provided by a Paediatric Bioethics Centre team (PBC) to PICU during the pandemic. METHODS: GOSH-PBC is a multidisciplinary group: laypeople - including former hospital parent, healthcare and other relevant professionals - which operates across 4 domains (i) Rapid Case Reviews (RCR) where children/families/professionals consider together difficult treatment decisions. (ii) Ethical staff support (ESS) to combat moral distress/injury(MDI), (iii) Research (iv) Education. Data sourced from the bioethics database March-July 2020 RESULTS: Initially, documents composed to support/guide hospital teams including PICU Activity highest in RCR: PICU referred 14 cases, 7 Sars-Cov-2 positive and 4 MIS for consideration of innovative therapies - all proceeded. COVIDnegative referrals: 3:one innovative surgery, two RRT/limitation considerations. Parents attended 6/14 meetings via video-link, met PBC shortly afterward (6/7). Existing ESS mechanisms adapted: 'coalface' PICU drop-in sessions replaced by (a) individual informal (socially-distanced) face-to-face support (1-3/day Monday-Friday) & (b) video-link group sessions (1-8/week, mean 4.6) - most to staff deployed to local overwhelmed adult ICUs. MDI card adapted for wellbeing hub. Research -support to PICU/ID PIMS-TS/MIS and COVID-19 publications and separate ethics pieces. Education - webcasts for local, national & international PICU teams. CONCLUSIONS: Bioethics support has been fundamental in challenging COVID-19 clinical decision-making for children, families & staff. Bioethical staff support has also been key.
ABSTRACT
The major impact of the COVID-19 pandemic has been on the health of adults. A small percentage of children have been acutely ill with COVID-19. Urgent reconfiguration of services with centralisation of paediatrics to free up resources for ill adults was carried out in North Thames and routine paediatric services at GOSH and in other Trusts curtailed. During a pandemic, the rights and interests of individuals can be trumped by a utilitarian approach to the provision of services such as health, education and social welfare. However, the ethical aspects of the impact of this on children's health requires consideration. Arguably, children have been the bystanders to this process without involvement of young people in planning these changes (Larcher and Brierley 2020). Children have not been able to access treatment locally and visiting was limited to one adult, even for those children with serious, life threatening illness. Face to face outpatient consultations for ill children have not been accessible and community AHPs and services for children with chronic disease and disability have not been availableThe principles of minimising harm, and ensuring distributive justice for children should be applied. Most children will recover from COVID- 19, but their future will be affected by the socio-economic consequences of the pandemic.Their right to an open future, necessarily entails that their future interests are fully considered.
ABSTRACT
During a pandemic, ethical concerns arise in relation to allocation of resources for seriously ill patients. The COVID-19 pandemic predominantly affected adults with a high associated morbidity and mortality, however it was anticipated that there would also be an impact on the paediatric population. There were four phases to the work of the Paediatric Bioethics Centre (PBC) service at GOSH: 1.Preparation: Documents to support/guide hospital teams and regional inpatient, community and hospice settings were prepared with colleague. We adapted existing 'ethics support' mechanisms to combat workforce moral distress, distress/injury. 2.Bioethics activity: was highest in the rapid response service where difficult treatment decisions were considered with clinical teams, families and young people. 12 reviews were carried out from March- May to consider experimental antiviral treatment, allocation of resources in the context of COVID-19 and non Covid cases considering a ceiling of treatment. Telemedicine facilitated the rapid response to these urgent cases and involved parents, including those not in the hospital. 3.Education: the service provided 'pandemic webcasts' on decision-making and broader child-health concerns. Staff support with other wellbeing services has been essential, especially for those deployed to overwhelmed local adult ICUs. 4. Reflection: focussed on (a) Research Re future deployment to minimise moral distress/injury, b) remote video-conferencing - parents/participants experience/ability to consider complex ethical issues and c) role of faith/non-faith in society's recovery. This work illustrates the importance of the role of the Paediatric Bioethics Service in a tertiary children's hospital during the COVID-19 pandemic.