The COVID-19 pandemic has created significant ethical conflicts for health care professionals, forcing them to move from a conventional, patient-focused standard of care to crisis care focused on the health of the overall population, according to a well-known medical ethicist.
Dr. Douglas Diekema, MD, MPH, director of education at the Treuman Katz Center for Pediatric Bioethics – Seattle Children’s Research Institute, was the keynote speaker at the 2020 William T. Cashdollar Distinguished Visiting Professorship presented by the UTHSC College of Nursing Nov. 6 via Zoom. More than 270 people registered for the virtual program.
“It is no longer a matter of making sure my patients get everything they need. It is now a question of which patients get everything they need,” he said.
Ethical questions come into play as health care professionals must prioritize who receives resources, he said. For example, it quickly became clear that personal protective equipment (PPE) should be available not just to health care professionals such as nurses and doctors, but also to health care workers, like cleaning staff, who are exposed to COVID-19 patients.
Dr. Diekema, who is a member of a regional emergency preparedness task force, also was involved in a decision in allocating the drug Remdesivir. The region received 100 doses of the drug, but had about 300 patients who needed it. The group decided that most of the drug should go to the county that had the most serious COVID-19 cases, he said. That county also had a large population of immigrant farm workers.
The response to the pandemic that has involved major shutdowns of schools and businesses and social distancing, also has presented problems for many, he said. “It is not about shutting everything down, but about being smart as we reopen our communities, wearing masks and doing the things we need to do to care for those who really don’t have the ability to care for themselves,” Dr. Diekema said.
Family members of COVID-19 patients have definitely suffered from the distancing required in health care settings. Sherry Webb, DNSc, RN, CNL, NEA-BC, associate professor and chair of the Department of Acute and Tertiary Care for the UTHSC College of Nursing, was a member of the program panel who shared her story of losing her 95-year-old mother to COVID-19 this year.
Dr. Webb’s mother contracted the virus while in rehabilitation for a broken hip. “That part of not being able to be at her bedside was probably the hardest thing for me,” she said.
While she was concerned that her mother’s needs weren’t being met because she couldn’t express them, Dr. Webb said she also understood how hard the nurses were working in the crisis situation. And she recalled the “window visits” she would make to her mother’s rehab center.
“When I think about her now,” Dr. Webb said, “The first thing I see is her lying in the bed with the foot of the bed up to the window and me standing on the ground with my hands and my head on the window trying to communicate with her.”
The pandemic has, in effect, pulled back the curtain on many unaddressed problems in the U.S., Dr. Diekema said. He cited the “inadequacy of the US health care system,” which is nearly driven into crisis operations every year by the flu season. He also cited the inadequacy of the market alone to respond to public health emergencies.
“You can’t address a public health emergency relying solely on capitalism,” he said. “There needs to be funding for the sort of things that benefit the general populations.”
Other issues that have led to the overall crisis of the pandemic include a lack of federal leadership, a lack of respect for education, science and expertise and “the malignant role of social media,” he said.
Courage, heart, and respect for knowledge and science are needed as the U.S. continues to respond to the pandemic, Dr. Diekema said. “Most of us know people who have lost family members from this disease. We need to keep that in mind. These are not statistics. These are real people suffering and dying.”