From its start in the mid-1980s when ventilators to keep people alive first came into common use, the Center for Practical Bioethics has helped patients, families, providers, and policymakers make decisions about what ought to be done in light of what can be done.
It has applied the tools of ethical analysis to help distraught parents decide whether to remove life support from their teenaged child after an accident. It has helped clinicians untangle complicated treatment options when incapacitated patients had no friend or family member to speak for them. It has helped elected officials consider the consequences – intended and unintended – of proposed health care policies and legislation.
Raising the Stakes
The coronavirus pandemic hasn’t changed the work of clinical ethics. But it did raise the stakes. In normal times, clinical ethics emphasizes the duty of providers to focus on the needs of the patient in front of them. In contrast, public health ethics, which takes precedence in pandemic situations, emphasizes justice and the common good. It asks the question: What can we do to provide the most benefit to the most people?
The coronavirus pandemic hasn’t changed the work of clinical ethics. But it did raise the stakes.
Providers and policymakers were struggling with how, as a region, to implement “Crisis Standards of Care,” which come into play when a public health event or natural disaster substantially impacts normal health care operations and the normal standard of care cannot be maintained.
Nursing homes, recognizing residents’ extreme vulnerability to succumbing to COVID-19, were asking how to adapt traditional, advance care planning approaches. They needed evidence-based tools and guidance on how to discuss treatment preferences with residents and families in light of the crisis. Would the resident, for example, want to be transferred to a hospital if their condition deteriorated?
Clinicians on the front lines were reaching out for help to cope with the moral distress they felt when faced with situations where what they were asked to do differed from what they perceived was the ethically correct thing to do.
New Resource Channels
By early March, the Center for Practical Bioethics knew that its mission – to raise and respond to ethical issues in health and health care – would require it to focus on providing ethical guidance through the pandemic, in addition to ongoing ethics consultation work for health care facilities throughout the metro area.
We developed three channels to provide this guidance:
- COVID ETHICS UPDATE: These 10-15 minute interviews and talks address ethical issues arising from the pandemic. Topics cover advance care planning, spiritual care, cultural issues, allocation of scarce resources, and more.
- WEBINARS: The Center introduced hour-long webinars featuring expert panelists to explore topics more in depth. As of June 11, webinars include Duties to Care, Ethical Dimensions of Quarantine and Isolation, Crisis Standards of Care, Triage and Clinical Practice, Advance Care Planning in Long-Term Care, Clinicians and Moral Distress, and African-American Religious and Spiritual Perspectives on COVID.
- PANDEMIC RESOURCES: Drawing from a firehose of COVID-19 information, the Center develops and curates resources to aid clinicians, providers, and policymakers in building ethics into their practices, institutions, and public health strategies.
In addition, the Center provides ethics perspective on several metro-area task forces and resource groups, such as BioNexus KC and the C19KC initiative to bring the life sciences and health care communities together, relying on science to mitigate the risk and spread of COVID-19.
As of this writing, states across the country, including Missouri and Kansas are re-opening despite some locales experiencing increased infection levels. The pandemic is not over, but the urgency to consider livelihoods over lives due to economic pressures poses ongoing ethical concerns for the foreseeable future.
The Center plans to continue to offer webinars on timely and vexing Covid-19 issues that raise challenging ethical considerations of interest to stakeholder groups, including the Regional Ethics Committee Consortium, health providers, policymakers, and administrators devoted to serving vulnerable populations.
Our Ethics Update series will also continue to cover topics that evolve as we move from emergency response and crisis standards to testing/tracing/supportive isolation and on to mitigation and containment, with the goal of reaching decay of the virus over time.
The next webinar takes place June 11, covering the topic of Saying the Distant Goodbye during COVID-19, Clinical Perspectives from Communities of Color, featuring a diverse panel of national experts and devoted health care providers. Download the pdf and register here.
Editor’s note: This post is part of a blog series that shares the impact of the pandemic on our grantees and community partners. If you would like to share your story, please find out more here.
Read how these community partners have responded to the pandemic: