In the Eye of the Storm: Bioethics in the Time of COVID-19
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RESPONSE TO COVID-19/ETHICS
In the Eye of the Storm: Bioethics in the Time of COVID-19 C. Ronald MacKenzie, MD & Douglas S. T. Green, MD & Mary F. Chisholm, MD & Seth A. Waldman, MD
Received: 4 June 2020/Accepted: 12 August 2020 * Hospital for Special Surgery 2020
Keywords COVID-19 . bioethics . scarce resources . ventilators . do-not-resuscitate . communication Introduction Planning in New York City for the arrival of COVID-19 began in earnest in early March 2020, with the healthcare system, including the bioethics community, in a heightened state of readiness. Informed by the Chinese and the Italian experience, we knew the storm was coming and thought we knew what had to be done. Still, an eerie sense of dread was pervasive, as only certain characteristics of SARS-CoV-2, the virus that causes COVID-19, were appreciated—its highly infectious nature, its predilection for the lungs, and the high risk it posed for certain patients. That no effective therapies existed and that the condition was often fatal fueled the disquiet. We present the story of COVID-19 as seen by the Bioethics Committee at the Hospital for Special Surgery (HSS)—who we are, what function we served, and how we helped during this trying, unprecedented period. The Stage Hospital ethics committees help resolve ethical dilemmas in the context of inpatient care. Clinicians find such dilemmas Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09791-3) contains supplementary material, which is available to authorized users. C. R. MacKenzie, MD (*) Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021, USA e-mail: [email protected] D. S. T. Green, MD : M. F. Chisholm, MD : S. A. Waldman, MD Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021, USA
familiar: defining goals of care, handling treatment refusals or discharge problems, determining patients’ decisionmaking capacity, among others. In ordinary circumstances, physicians resolve these quandaries using a patient-centered orientation, yet these were far from ordinary circumstances! Indeed, COVID-19 presented a point of inflection unfamiliar to all healthcare professionals, one necessitating a shift from the usual patient-centered care, our comfort zone, to an orientation targeting the greater public good, a stressful shift for those who provide frontline medical care [1, 6]. Indeed, challenges specific to pandemics are among the most difficult [9]. The allocation of resources in limited supply, the emotionally charged family discussions concerning goals of care, and the decisions about resuscitation or initiation (or termination) of mechanical ventilation are some of the circumstances that can be anticipated and with which the bioethicist can assist. That the pandemic would strain healthcare resources was widely foreseen, resulting in a number of procedural enhancements to our usual practices at HSS. T
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