Ethics of Care in the Time of Covid-19

UP experts: PHL Covid cases could rise to 40,000 by end of June businessmirror.com.ph/2020/06/11/up-experts-phl-covid-cases-to-rise-to-40000-by-end-of-june/

Cebu City hospitals run out of beds for COVID-19 patients

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Cebu City hospitals run out of beds for COVID-19 patients CEBU CITY—The city’s hospitals have run out of space for COVID-19 patients, prompting the Department of Health (DOH) in Central Visayas to request the health facilities to dedicate more beds for

275,000 lives have been lost to the COVID-19 pandemic, and this number continues to rise. The duty to provide care extends from the moment patients are hospitalized until after they are laid to rest.

Even in death, patients have a right to decide how they want their bodies to be disposed. However, the risk of transmission and the prohibitions against mass gatherings prevent customary burials from taking place.

Should patients’ final wishes take precedence over public safety?

The 30th and final guideline tackles post-mortem care.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

Hospital teams on duty are being run to the ground. They care for patients in the sweltering confines of full PPE for hours, unable to rest and sometimes even use the bathroom until the end of their shift. In these conditions, HCWs on duty may not have the time nor energy to fully orient the patients and their family about the many aspects of their care such as advance directives, research trials, informed consent and the like. HCWs may also have to face a number of ethical dilemmas involving patient care which puts additional moral, emotional and psychological strain on these already ragged workers.

What can the hospital do to help ease the burden of communication and decision making on duty teams without compromising quality of care and ethical principles?

Guidelines 27-29 expound on the role of various Working Committees.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

The healthcare worker team consists of doctors, nurses, aides, laboratory technicians & workers, medical waste managers, security, custodians, and every person in the hospital who has a role in delivering care and services to the sick.

However, with a PPE shortage, colleagues who have fallen ill, interminable shifts, and no clear solution, the stress mounting on healthcare workers cannot be denied.

What protections and rights do our healthcare workers have? What can we do to ensure that those who care are taken care of as well?

Guidelines 24-29 are on Healthcare Workers' Right and Obligations.
Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

Research, alongside public health, is at the forefront of the world’s fight against COVID-19. Research has led to the discovery of the virus’s DNA sequence, innovations in testing, new ventilator technologies, and alternate uses for some medications. Hopefully, it will lead to the development of a vaccine.

There is a constant, urgent need for possibly life saving data and innovations, but does this mean we can fast track, or even do away with, some research protocols or standards?

Guidelines 20-23 are on conducting Research during a pandemic scenario.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

Information and data gathering is key in responding to a public health crisis. It gives us a clear, objective picture of the situation at hand, and it can offer hope in the form of dwindling infection rates and rising recovery numbers. Unfortunately, the reverse is also possible if case numbers continue to rise. It will be impossible to move forward and stay one step ahead of this virus without collecting accurate data.

Even with the Data Privacy Act or amidst reports of stigmatization against COVID-19 patients and their caregivers, does the public health need for information and data trump individual rights?

Guidelines 17-19 are on Information Management.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

The pandemic has caused the disruption of normal societal functions and routines. Patients are hindered from availing certain health services because of the community quarantine. However, those with severe conditions, or who require regular follow-ups and procedures like dialysis or chemotherapy still need to visit the hospital.

When the entire world is focused on stopping the pandemic, how do we make sure that the needs of non-COVID-19 patients are not forgotten?

Guidelines 14-16 tackle ethics in caring for non-COVID-19 patients.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

Around 200+ new cases of COVID-19 are being reported daily and we are constantly reminded of how quickly this pandemic is overwhelming our health-care systems. The current number of ventilators in the country is only half of the number needed during a health crisis which puts healthcare workers in a position to make difficult (if not morally impossible) decisions about the allocation of limited resources.

Guidelines 12-13 are focused on ICU Care, specifically the selection criteria for ICU admission and allocation for ventilator use.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

With no known cure against COVID-19, doctors and patients are walking into a battle with experimental weapons.

Standards of care are still being established, and patients are currently treated with investigational therapies.

In these uncertain times, how do we regulate medicines for off-label use and how can we give patients an active role in their treatment?

See Guidelines 10-11 on Therapeutic Interventions.

Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

The following is an excerpt from a recently circulated text message:

“Though *name redacted* shows spontaneous respiration, her brain activity remains to indicate that she has 0% chance of waking up. The medical team has been calling her husband and asking for his permission to pull the plug and mark her "DNR" (Do not Resuscitate) but he and their children are not ready yet and have asked for Full Code (Full Support). It's an extremely difficult situation even for the medical team as they need the labor and equipment they need for other patients.”

This is what reality is out there as we deal with this COVID crisis. How do we reduce both familial and professional distress in such uncertain times? Does advanced care planning have a role during this pandemic?

See Guidelines 5-9 on Communication of Care. Full E-Book of the guidelines can be accessed athttps://ethicists.org/covid-ethics-v1.pdf

Thank you to The Philippine College of Physicians and Dr. Susan P. Añonuevo-Dela Rama (Chair of the Committee on Ethics) for your kind endorsement! We greatly appreciate all your contributions in formulating these guidelines and we look forward to working together once again for the further improvement of this document.