A novel ethical approach to moral distress during COVID 19 in New York

Abstract

The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress.

Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic

“… 62 , 63 Other interventions such as priority-setting guidelines 62 and designation of clinical teams to support clinicians when making difficult decisions about withholding or withdrawing life-sustaining treatments also have been described as highly valuable and effective in mitigating moral distress. 25 , 64 …”

The First COVID-19 Pandemic Wave and the Effect on Health Care Trainees: A National Survey Study

“…17,18 During the height of the initial wave, many resident physicians were assigned to the critical care units, with limited supervision, and being asked for the first time to make life-altering decisions on patients who were unresponsive to standard therapeutic options. Such decisions were never asked of these junior physicians, and in the survey, [19][20][21][22] we asked our learners to identify factors important to allocation of ventilators at a time when medical and human resources were stretched to the limit. The results showed congruent decisions nationally made for patient selection in ventilatory support; trainees used highest probability of survival as the initial preference, followed by clinical critical condition, age, health care worker, multiple comorbid conditions, and first come first serve method.…”