Ethical Implications of COVID-19

Abstract

Outbreaks of COVID-19 among nursing homes, assisted living facilities, and other long-term care facilities in the United States have had devastating effects on residents. Restrictions such as banning visitors, sequestering residents, and testing health care staff have been implemented to mitigate the spread of the virus. However, consequences include a decline in mental and physical health, decompensation, and a sense of hopelessness among residents. We present and explore a case study at an assisted living facility addressing the ethical issues in balancing the management of the community versus the resident's right to autonomy and self-determination. A team of palliative care experts was brought into assisted living facilities to manage patients, care for well residents, and provide input in advance care planning and symptom management. The principles of self-determination and autonomy, stewardship, and distributive justice were explored. The use of nursing skills in triage and assessment, principles in public health, and the 8 domains of palliative care provided a comprehensive framework for structuring emergency operations. Palliative interventions and the role of palliative care nurses played an integral part in addressing ethical challenges in the containment of the virus and the deleterious effects of social isolation among the elderly.

Situation, Education, Innovation, and Recommendation: A Large-Scale Systematic Review of Advance Care Planning in the Age of COVID-19

“…This lack of awareness or knowledge of ACP was identified as a major barrier [ 55 , 64 , 66 , 86 , 90 , 125 ]. Some studies noted a need for adequate ACP training for clinicians as a barrier [ 76 , 91 , 142 ]. Moreover, the findings of our review indicate that certain communities experienced or were vulnerable to a lack of engagement in ACP due to a combination of factors; disparities in health education [ 90 ], cultural and religious beliefs [ 57 , 86 , 90 , 142 ], socioeconomic challenges [ 57 , 140 ], a general distrust in the healthcare system [ 65 , 124 , 125 , 137 ], and racial or ethnic barriers [ 53 , 90 , 124 , 140 ] played significant roles.…”

“…For this category, the table includes only the Study ID, country, quality assessment, and coded barriers and facilitators. The COVID-19 pandemic spurred many experts in the field to write recommendations regarding ACP, emphasizing its importance and utility for healthcare systems [142,146]. The manuscripts within the Recommendation category emphasized the need for ACP to be patient-and family-centered, addressing both general and acute serious illness-specific preferences [124][125][126].…”

Ethical Issues in Long-term Care in Low-, Middle- and High-Income Countries During the COVID-19 Pandemic

“…Physical isolation of older adults is associated with increased rates of morbidity and mortality, with markedly reduced health outcomes specifically in LTC settings (Friedler et al, 2015; Parekh de Campos & Daniels, 2021). Due to the shared living environment in many LTCs, efforts to mitigate the spread of coronavirus among vulnerable populations during the height of the pandemic resulted in progressively restrictive IPAC practices in many LTCs, posing medico-legal ethical dilemmas (Liddell et al, 2021; Parekh de Campos & Daniels, 2021). Residents faced forced confinement across global LTCs, with a notable number of survey responses stating that confinement of loved ones was a major ethical challenge during the pandemic.…”

“…In restricting the physical movements of LTC residents, the ability for residents to self-determine their navigation of their space was notably absent, due to the risks posed to the welfare of their community members around them. While the ethical principles of social accountability and self-determination are often debated in the context of COVID-19 policies in LTC, there is a growing body of evidence showing that the effects of isolation during the pandemic has caused irreversible psychological and physical harms not only to residents, but to their family and staff caregivers (Parekh de Campos & Daniels, 2021).…”

Integrating Palliative Care into Nursing Care

“…The need to align patients' wishes with their rapidly changing health conditions has brought to light the importance of early communication regarding palliative care. But nurses—who have been responsible for conducting vital conversations about advance care planning, resuscitation status, and transitions of care12—have faced communication challenges caused by systemic barriers such as isolation protocols and visiting restrictions,13 as well as by their own discomfort discussing palliative care 10. To address this gap, specialty palliative care nurses have stepped in to facilitate communication with patients and families on such topics as the goals of care, the illness trajectory, hopes and expectations, prognosis, life-sustaining treatments, hospice, and end-of-life care 12, 14.…”