The struggle for good care: moral challenges during the COVID-19 lockdown of Dutch elderly care facilities

Abstract

The COVID-19 lockdown of Dutch long-term care facilities between March and May 2020 affected the quality of lives of residents and opposed professional and personal ethics of care. This article, based on 25 in-depth interviews with healthcare chaplains, gives insight into what moral challenges appeared for care professionals. Moral challenges were related to: ‘family ruptures’, ‘residents’ loneliness and despair’, ‘cold-hearted deaths’ and ‘response and responsibilities’. The findings illuminate the complexity of providing care during the lockdown and show variation in the impact of these ethical experiences, in which both moral distress and moral resilience occurred.

Dignity reflections based on experiences of end‐of‐life care during the first wave of the COVID‐19 pandemic: A qualitative inquiry among bereaved relatives in the Netherlands (the CO‐LIVE study)

“…The question arises whether health care professionals recognised their own ethical position in these moments in which residents of nursing homes 'gave up on life'. An earlier study highlighted the importance of health care professionals to ethically act against dehumanising care practices which require courage and willingness to speak up or disobey [33]. These moments can be described as 'tipping points' (In Dutch; Kantelmoment [34]); a critical moment in which different key values clash and a professional is unsure about what is the right thing to do.…”

Moral failure, moral prudence, and character challenges in residential care during the Covid-19 pandemic

“…Especially nurses in residential care witnessed the impact of social isolation on many residents, trying to compensate the loss of social connection, among others, by the use of social media. 29,33 Against this background, it is difficult-if not presumptuous-to identify at what point, one can speak of a moral failure at an individual level. Additionally, the "heroization" of nurses and other healthcare professionals in the pandemic can be assumed to have complicated the focus on issues of moral agency in the light of exacerbated resident vulnerability and intergenerational social justice.…”

“…Health professionals were often the only ones who had ongoing access to residents and knew the impact of visiting bans on resident's physical and mental health, 2,4,7 but they did not necessarily consider themselves as moral agents entitled to address or question the practice of shielding, even though they experienced first line its deleterious effects. 29,33,51 Regarding the ethical evaluation of this practice and its reference to moral character, Geoff Moore's account of Alasdair MacIntyre's virtue framework 52,53 for the context of professional practice is clarifying: First, it basically contends that "practice" has to be considered a morally thick term insofar-in MacIntyre's sense-it inherently produces morally valuable goods and agents have therefore to meet the requirements of moral character. Consequently, there cannot be such thing as a space of practice outside of moral agency.…”

“…And, of course, there were many nurses and doctors who secretly granted exceptions to strict visiting rules, for example, by interpreting generously the term "palliative situation" (which justified an exception in many places), because they were emotionally overwhelmed by the suffering of residents or silently resisted the practice of shielding. 33 As the example of Switzerland illustrates, 6,11 this development was reinforced by the attitude of health authorities, which gave residential care facilities wide discretionary powers, often leaving managers no alternative but to stick to the practice of shielding for fear of liability issues. 6,12,13 Most surprising, however, was the scant attention paid to the increasing evidence of the disastrous effects of prolonged visitation bans on residents’ lives and coupled with the very high Covid-19-related mortality of residents in many high-income countries.…”

“…Health professionals were often the only ones who had ongoing access to residents and knew the impact of visiting bans on resident’s physical and mental health, 2,4,7 but they did not necessarily consider themselves as moral agents entitled to address or question the practice of shielding, even though they experienced first line its deleterious effects. 29,33,51…”