An ethical conundrum: Palliative care in the COVID-19 pandemic

Tam, Kuai In

doi:10.1017/s1478951521000055

Cited by 4 publications

(1 citation statement)

References 9 publications

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“…Indeed, the implementation of resuscitation manoeuvres can certainly prevent premature death but, at the same time, may prolong agonizing conditions, cause discomfort, aggravate the emotional distress of the patients and their family, and lead to a waste of resources [2]. In this context, the relationship between patients and clinicians is of pivotal importance to assure the right intervention even at last stages of life [3]. Do-not-intubate (DNI) orders identify the advanced directive of the patient to not proceed towards intubation and mechanical ventilation in case of acute respiratory distress or dyspnoea.…”

Section: Introductionmentioning

confidence: 99%

Treatment of patients with ‘do not intubate orders’

Cammarota

Simonte²,

Robertis³

2023

Current Opinion in Anaesthesiology

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Purpose of reviewDo-not-intubate (DNI) orders are more frequently encountered over time. This widespread diffusion of DNI orders make it essential to develop therapeutic strategies matching patient's and his family willingness. The present review sheds light on the therapeutic approaches employed to support respiratory function of patients with DNI orders.Recent findingsIn DNI patients, several approaches have been described to relieve dyspnoea and address acute respiratory failure (ARF). Despite its extensive use, supplemental oxygen is not so useful in assuring dyspnoea relief. Noninvasive respiratory support (NIRS) is frequently employed to treat ARF in DNI patients. Also, to enhance DNI patients comfort during NIRS, it is worthy to point out the role of analgo-sedative medications. Lastly, a particular aspect concerns the first waves of coronavirus disease 2019 pandemic, when DNI orders have been pursued on factors unrelated to patient's wishes, in the total absence of family support due to the lockdown policy. In this setting, NIRS has been extensively employed in DNI patients with a survival rate of around 20%.SummaryIn dealing with DNI patients, the individualization of treatments is of pivotal importance to respect patient's preferences and improve quality of life at the same time.

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Section: Introductionmentioning

confidence: 99%

Treatment of patients with ‘do not intubate orders’

Cammarota

Simonte²,

Robertis³

2023

Current Opinion in Anaesthesiology

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Urgent Need to Address the Immense Suffering Due to the COVID-19 Pandemic Surge: Subcutaneous Route to the Rescue!

Sharma¹,

Seshachar

Macaden

et al. 2022

IJPC

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The worst thing we can do is abandon someone who is hurting. Attitudes which promote death rather than affirm life are the ultimate abandonment. ' -Dame Cicely Saunders. The second wave surge of the COVID-19 pandemic in India has presented a challenge to urgently mitigate the immense suffering. The rapid spread due to the variant, airborne transmission, and flaunting of prevention guidelines has resulted in fear and panic. The rapid deterioration in severe COVID infection results in total suffering, which is physical, emotional, social, financial, and spiritual for both the person and family. Compounding this is the overwhelmed health-care system resulting in a lack of vaccinations, oxygen, hospital and ICU beds. All these lead to despair, anguish, and hopelessness. How can we mitigate this immense suffering? There is a need for a more effective integration of palliative care with COVID care at all levels. A recent BMJ article outlines palliative care for patients with serious COVID-19. [1] This integration must result in a better quality of life and recovery as the immediate goal and also better quality of death if it is inevitable. This is wartime and the need of the hour is for all palliative care teams to prioritise this need and be involved in effective palliative care integration with COVID care, in addition to their primary area of responsibility. In the context of severe COVID infection, the acute shortages of hospital and ICU beds can only be addressed by making the bed at home functional. Desperate families need to be supported and empowered to take care of their loved ones at home by both COVID care and palliative care joining hands and adhering strictly to all personal protection measures. This can be done by effective use of the subcutaneous route (SC) for symptom control coupled with simultaneous ongoing specialist COVID care support including oxygen provision as possible.https://jpalliativecare.com/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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The importance of providing palliative care for patients with severe COVID-19 in Indonesia

Effendy

Kristanti

2021

Belitung Nurs J

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Patients with Coronavirus Disease 2019 (COVID-19), particularly those with a severe condition, might not survive. Pandemic situation challenges the healthcare providers in addressing palliative care to the patients. This paper aimed to describe the importance of providing palliative care for patients with severe COVID-19 in Indonesia. We used a case scenario to illustrate the common condition experienced by a patient with severe COVID-19. Health care providers in Indonesia could address palliative care for patients with COVID-19 by focusing on controlling the symptoms, avoiding futile intervention, and connecting the patients and their families. Nurses need to consider the patients’ needs for family supports, even though not in physical or psychosocial support, and help the patients who need end-of-life care to be dying with dignity. Communication technology must be utilized optimally by healthcare providers to realize the communication among the patients, families, and health workers.

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An ethical conundrum: Palliative care in the COVID-19 pandemic

Cited by 4 publications

References 9 publications

Treatment of patients with ‘do not intubate orders’

Treatment of patients with ‘do not intubate orders’

Urgent Need to Address the Immense Suffering Due to the COVID-19 Pandemic Surge: Subcutaneous Route to the Rescue!

The importance of providing palliative care for patients with severe COVID-19 in Indonesia

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