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1.
Hastings Cent Rep ; 50(3): 12-13, 2020 May.
Article in English | MEDLINE | ID: covidwho-2074981

ABSTRACT

In a field that strives to care for patients and families together, what can palliative care clinicians do when patients' families are physically absent? The Covid-19 pandemic has put both literal and figurative walls between health care professionals and families. How health care workers respond to these disconnections might have a lasting impact on patients, on families, and on our practice. Recently, I saw this in the case of a patient our palliative care team was consulted to see. Mr. B was minimally responsive and dying from multisystem organ failure of unclear etiology. As in other cases during this pandemic, our team became a facilitator of interaction between the patient and the physically absent family, seeing an intimacy we normally would not, in this case, by being present while our intern held the phone to Mr. B's ear for an end-of-life call from his wife, son, and daughter. Such moments force us clinicians to be even more present for our families and patients, and they allow us to bear witness to the strength and sadness and love that we might otherwise miss.


Subject(s)
Coronavirus Infections/epidemiology , Family/psychology , Palliative Care/organization & administration , Palliative Care/psychology , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Ethics Consultation , Humans , Pandemics , SARS-CoV-2
2.
J Contin Educ Nurs ; 53(7): 297-298, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1924355

ABSTRACT

Ethics consultation services were first implemented in the 1970s to provide physicians, other care providers, and family members with expert advice to address difficult ethical dilemmas in care. As nurses are increasingly confronted with moral dilemmas related to patient preferences, needs, and choices that conflict with their personal beliefs, the need for professional support has never been greater. This need may signal a new role for ethics consultation services. [J Contin Educ Nurs. 2022;53(7):297-298.].


Subject(s)
Ethics Consultation , Physicians , Caregivers , Conflict, Psychological , Humans , Morals
7.
Nurs Ethics ; 29(4): 833-843, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1731442

ABSTRACT

BACKGROUND: The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics-Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. OBJECTIVES: The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was to describe the Cell's functions during that period. RESEARCH DESIGN: This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient's/designated representative's preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. PARTICIPANTS AND RESEARCH CONTEXT: Only our university hospital's clinicians could request EST intervention. ETHICAL CONSIDERATIONS: The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. FINDINGS/RESULTS: 33 requests (patients' mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. DISCUSSION: Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. CONCLUSIONS: COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions.


Subject(s)
COVID-19 , Ethics Consultation , Aged, 80 and over , Ethics Committees, Clinical , Female , Health Personnel , Humans , Male , Morals
8.
Med Intensiva (Engl Ed) ; 45(9): 563-565, 2021 12.
Article in English | MEDLINE | ID: covidwho-1517388
9.
JCO Oncol Pract ; 17(3): e369-e376, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1262524

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient's concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.


Subject(s)
COVID-19 , Cancer Care Facilities , Ethics Consultation/trends , Neoplasms , Resuscitation Orders/ethics , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell , Cardiopulmonary Resuscitation/ethics , Child , Decision Making , Ethics Committees, Clinical , Female , Health Care Rationing/ethics , Hematologic Neoplasms , Humans , Intensive Care Units , Intubation, Intratracheal/ethics , Kidney Neoplasms , Lung Neoplasms , Male , Medical Futility , Mental Competency , Middle Aged , Multiple Myeloma , New York City , Occupational Health/ethics , Patients' Rooms , Personal Autonomy , Proxy , SARS-CoV-2 , Sarcoma , Young Adult
10.
J Med Ethics ; 48(4): 244-249, 2022 04.
Article in English | MEDLINE | ID: covidwho-1166559

ABSTRACT

BACKGROUND: The quality of ethics consults is notoriously difficult to measure. Survey-based assessments cannot capture nuances of consultations. To address this gap, we conducted interviews with health professionals who requested ethics consults during the initial phase of the COVID-19 pandemic. METHOD: Healthcare professionals requesting ethics consultation between March 2020 and May 2020 at a tertiary academic medical centre were eligible to participate. We asked participants to comment on the consults they called and thematically analysed responses to identify features associated with optimal quality consultations. RESULTS: Of 14 healthcare providers, 8 (57%) were women and professions were as follows: 11 (79%) medical doctors, 1 (7%) social worker, 1 (7%) physician assistant and 1 (7%) nurse practitioner. Two aspects of quality emerged: satisfaction and value. Themes within the domain of satisfaction included: responsiveness of the ethics consultant, willingness to consult, institutional role of the ethics service and identifying areas for improvement. When describing value, respondents spoke of the intrapersonal and interpersonal worth of consultation. CONCLUSION: Participants were generally satisfied with ethics consultation services, similar to opinions of those found in pre-COVID-19 survey studies. Our qualitative approach allowed for a richer exploration of the value of ethics consultation during the pandemic and has implications for ethics consultation services more broadly. Ethics consultation-emphasising both the process and outcome-created valuable moral spaces, promoting thoughtful and ethical responses to dilemmas in patient care. Future assessments should incorporate patient and family/surrogate perspectives and explore the domain of education as an additional quality measure.


Subject(s)
COVID-19 , Ethics Consultation , Physicians , Ethicists , Female , Humans , Pandemics
12.
Hastings Cent Rep ; 50(5): 17-19, 2020 09.
Article in English | MEDLINE | ID: covidwho-888081

ABSTRACT

The Covid-19 pandemic has brought about renewed conversation about equality and equity in the distribution of medical resources. Much of the recent conversation has focused on creating and implementing policies in times of crisis when resources are exhausted. Depending on how the pandemic develops, some communities may implement crisis measures, but many health care facilities are currently experiencing shortages of staff and materials even if the facilities have not implemented crisis standards. There is a need for shared conversation about equality and equity in these times of contingency between conventional and crisis medicine. To respond well to these challenges, I recommend that institutions rely on policy, professional education, and ethics consultation. As is the case with crisis policies, creating contingency policies requires that health care professionals decide on how, specifically, to achieve equity. A policy is only as effective as its implementation; therefore, institutions should invest in context-specific education on contingency policies. Finally, ethics consultation should be available for questions that contingency policies cannot address.


Subject(s)
Coronavirus Infections , Disaster Medicine , Health Care Rationing , Health Equity , Health Resources/supply & distribution , Healthcare Disparities , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Disaster Medicine/ethics , Disaster Medicine/standards , Ethics Consultation , Health Care Rationing/ethics , Health Care Rationing/methods , Health Policy , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Resource Allocation , SARS-CoV-2
13.
J Med Ethics ; 46(6): 351-352, 2020 06.
Article in English | MEDLINE | ID: covidwho-828559
14.
Hastings Cent Rep ; 50(3): 16-17, 2020 May.
Article in English | MEDLINE | ID: covidwho-631127

ABSTRACT

Mrs. Clark's case was an ordinary consult in an extraordinary time. She was refusing dialysis, but the psychiatric unit had concluded that she lacked capacity for such decision-making. The only difference between Mrs. Clark's current hospitalization and the last two was that it was April 2020 and a virus called Covid-19 had overtaken our hospital. As the chief of Montefiore Medical Center's bioethics service, when I received a consult before the virus, I always saw the patient. Whether the patient had been in a vegetative state for a day or for years, it didn't matter. I would lay my hand on a leg or an arm and observe. But Covid-19 enforced physical boundaries between my team and our patients; I would not be able to meet Mrs. Clark. Our hospital responded to the attack on human connection by getting creative. We asked ourselves, which tools are still available to us? Answering this involved, in part, finding new ways for our team of clinical ethicists to support the clinicians caring for Mrs. Clark.


Subject(s)
Bioethical Issues , Coronavirus Infections/epidemiology , Mental Competency/psychology , Mental Disorders/psychology , Pneumonia, Viral/epidemiology , Social Media , Betacoronavirus , COVID-19 , Ethics Consultation , Humans , Pandemics , Renal Dialysis/ethics , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , SARS-CoV-2
15.
Gesundheitswesen ; 82(6): 507-513, 2020 Jun.
Article in German | MEDLINE | ID: covidwho-623537

ABSTRACT

In this paper we describe the process and content of our ad hoc public health ethics consultation for a Bavarian health authority in relation to Covid-19.


Subject(s)
Ethics Consultation , Pandemics/ethics , Public Health , Betacoronavirus , COVID-19 , Coronavirus Infections , Germany , Humans , Pneumonia, Viral , SARS-CoV-2
16.
Hastings Cent Rep ; 50(3): 13-15, 2020 May.
Article in English | MEDLINE | ID: covidwho-620255

ABSTRACT

I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, "You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her." Madeleine, who was twenty-four years old, was dying of end-stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical treatment-in my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid-19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients' and families' experiences at the end of life during a pandemic.


Subject(s)
Bereavement , Coronavirus Infections/epidemiology , Death , Family/psychology , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Ethics Consultation , Humans , Pandemics , SARS-CoV-2
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