Ethical support to picu during the COVID-19 pandemic

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 3one 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.