Visitor Restrictions During COVID-19 Pandemic May Impact Surrogate Medical Decision-Making

COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

“…Our findings underscore the need to distinguish the different roles within the umbrella term of “visitors.” This term disregards or minimizes the critical roles of family and other caregivers of dependent older persons, who serve as surrogate decision‐makers, provide critical medical information, lend emotional support, and advocate for care quality on their behalf. 32 , 33 In the case of persons living with advanced dementia, caregivers serve the invaluable role of interpreting the non‐verbal clues of these persons, who otherwise may communicate pain, fear, overstimulation, or an unmet need only through agitation. 34 The roles of caregivers of older adults may practically parallel those of parents of young children, and the fact that parents were most likely to be granted an explicit exemption from visitor policies in our study demonstrates that hospitals recognize the benefit of such critical roles in the care of the patient.…”

“… 45 Although technological solutions have been heavily used to connect patients, families, and medical teams virtually during the pandemic, face‐to‐face interactions remain the gold standard for complex decision‐making involving multiple parties. 32 Even in situations where exceptions to visitor restrictions exist, we expect that such exceptions would be extended only to family or caregivers and may exclude others, such as clergy or close family friends, who may nonetheless offer relief and comfort to terminal patients.…”

Early DNR in Older Adults Hospitalized with SARS-CoV-2 Infection During Initial Pandemic Surge

“…Furthermore, visitation restrictions likely precluded high-quality discussions with patients and their surrogates, biasing decision-makers toward a default of full code. 19 Overestimating survivability due to a lack of contemporaneous, high-quality data on inpatient post-arrest mortality in COVID-19 may have delayed code discussions between providers, patients and caregivers. Last, fears that early DNR orders will lead to less access to scarce resources (like ventilators) or less overall care may have also contributed.…”

A Theoretical Framework for Ethical Decision-Making During Public Health Emergencies

“…The rapid worldwide spread of the SARS-CoV2 infection and the resulting surge in the need for healthcare services precipitated value-based decision-makings in various healthcare services including, hospitals, outpatient services, health surveillance services. These decisions include considerations for access to intensive care services at the peak of care demand (15), patient and physician autonomy (16), privacy and confidentiality (17), cultural diversity (18), surrogate decision-making (19), micro-allocation of scarce resources (20), futile treatment (21), relations in the medical team (22) and approach to particularly vulnerable groups such as the elderly, pregnant women, pediatric patients and the limitation of therapeutic efforts (23).…”