Family Presence for Patients and Separated Relatives During COVID-19: Physical, Virtual, and Surrogate
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SYMPOSIUM: COVID-19
Family Presence for Patients and Separated Relatives During COVID-19: Physical, Virtual, and Surrogate Teck Chuan Voo Clarence C. Tam
&
Mathavi Senguttuvan &
Received: 10 May 2020 / Accepted: 3 August 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract During an outbreak or pandemic involving a novel disease such as COVID-19, infected persons may need to undergo strict medical isolation and be separated from their families for public health reasons. Such a practice raises various ethical questions, the characteristics of which are heightened by uncertainties such as mode of transmission and increasingly scarce healthcare resources. For example, under what circumstances should non-infected parents be allowed to stay with their infected children in an isolation facility? This paper will examine ethical issues with three modes of “family presence” or “being there or with” a separated family member during the current COVID-19 pandemic: physical, virtual, and surrogate. Physical visits, stays, or care by family members in isolation facilities are usually prohibited, discouraged, or limited to exceptional circumstances. Virtual presence for isolated patients is often recommended and used to enable communication. When visits are disallowed, frontline workers some-
T. C. Voo (*) : M. Senguttuvan Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, Clinical Research Centre, #02-03, 10 Medical Drive, Singapore 117597, Singapore e-mail: [email protected] C. C. Tam Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
times act as surrogate family for patients, such as performing bedside vigils for dying patients. Drawing on lessons from past outbreaks such as the 2002-2003 SARS epidemic and the recent Ebola epidemic in West Africa, we consider the ethical management of these modes of family presence and argue for the promotion of physical presence under some conditions. Keywords COVID-19 . Family presence . Medical isolation . Family separation . Communication . Epidemics . Outbreaks
Public health responses to epidemics involving a novel, highly-infectious, and potentially deadly pathogen such as SARS-CoV-2 (which causes COVID-19) typically include medical isolation of infected patients to prevent and contain spread.1 These measures raise complex issues relating to family separation. For example, under what circumstances should uninfected parents be allowed to stay with their infected children in an isolation facility? Should relatives be allowed to see a dying patient for possibly one last time when routine visitation has been suspended? Many COVID-19 patients in affected countries have died alone in isolation facilities (Horowitz and Bubola 2020), as happened during past epidemics of Severe Acute Respiratory Syndrome (SARS) in 2002–2003 (Pang 2013), Middle East 1 Strict medical isolation may also
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