Cardiothoracic surgeons in pandemics: Ethical considerations

Drake, Daniel H.; Morrow, Cynthia D; Kinlaw, Kathleen; Bonis, Michele De; Zangrillo, Alberto; Sade, Robert M.; Blitzer, David; Carpenter, Andrea J.; Ceppa, Duy Khanh P.; Chen, Edward P.; Cohen, Robbin G.; D’Amico, Thomas A.; Entwistle, John W.; Fedak, Paul W.M.; Fenton, Kathleen N.; Loebe, Matthias; Mayer, John E.; McKneally, Martin F.; Merrill, Walter H.; Millikan, Scott J.; Moffatt-Bruce, Susan D.; Murthy, Sudish C.; Naunheim, Keith S.; Pickens, Allan; Ray, Shuddhadeb; Romano, Jennifer C.; Starnes, Sandra L.; Swain, Julie A.; Tweddell, James S.; Whyte, Richard I.; Wood, Douglas D.; Zwischenberger, Joseph B.

doi:10.1016/j.jtcvs.2020.03.117

Cited by 13 publications

(15 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The article, "Cardiothoracic Surgeons in Pandemics: Ethical Considerations," by Drake et al [1] is of special importance to trainees. The pandemic has affected every aspect of cardiothoracic surgery, including the decline in elective and emergent case volume, rationing of resources, and redistribution of surgical staff to other domains.…”

Section: Ethical Guidelines and Moral Distress During The Covid-19 Pandemic: The Trainees' Perspectivementioning

confidence: 99%

Ethical Guidelines and Moral Distress During the COVID-19 Pandemic: The Trainees’ Perspective

Han

Luc

2021

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Ethical Guidelines and Moral Distress During The Covid-19 Pandemic: The Trainees' Perspectivementioning

confidence: 99%

Ethical Guidelines and Moral Distress During the COVID-19 Pandemic: The Trainees’ Perspective

Han

Luc

2021

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Whatever its label, the psychological damage suffered by HCPs during the pandemic is considerable, and we are grateful to Han and Luc for emphasizing the mitigating potential of ethical guidelines in response to our article. 6 30 Courtenay Dr, Ste 277, MSC 295 Charleston, SC 29425-2950 email: sader@musc.edu…”

Section: Ethical Guidelines and Psychological Distress In A Pandemicmentioning

confidence: 99%

Ethical Guidelines and Psychological Distress in a Pandemic

Sade

2021

The Annals of Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

The article, "Cardiothoracic Surgeons in Pandemics: Ethical Considerations," by Drake and coworkers 1 is of special importance to trainees. The pandemic has affected every aspect of cardiothoracic surgery, including the decline in elective and emergent case volume, rationing of resources, and redistribution of surgical staff to other domains. One area that can be overlooked, however, is the potential long-term consequence of incurring moral distress, especially for those in early, formative stages of training.The pandemic raises ethical concerns regarding limited resource allocation. At the frontlines of patient management these concerns are not academic or theoretical but rather carry significant implications for the well-being of patients and providers alike. 2 The burden of decision-making necessarily falls on providers on a case-by-case basis when the shift from a patientcentered to a public interest approach becomes necessary, including prioritizing number of lives and life-years saved. When life-support devices must be withdrawn from 1 patient to provide to another with greater need, rightfully so as recommended by guidelines, 1 these decisions should not be made by bedside clinicians but by specially designated triage teams; nevertheless patient care teams will observe these difficult decisions being made and must be deeply distressed when they become necessary. Although such deliberations and observations may help each of us grow as physicians and hone our ethos, surely the psychological toll of these times will have long-term consequences for everyone involved, especially trainees.Ethical guidelines such as the one put forth in The Annals of Thoracic Surgery and tiered triage guidance statements for adult cardiac surgery, 3 congenital heart surgery, 4 and thoracic malignancies 5 provide peace of mind and moral protection to trainees to allow them to focus on performing their clinical duties without becoming overwhelmed with many of the unknowns and unanswerables. We applaud cardiothoracic surgery leadership for their development of resource utilization predictions tools based on data from The Society of Thoracic Surgeons Database to assist healthcare providers in making informed resource allocation decisions and triaging cardiothoracic surgical cases. As we navigate the uncharted territory together, ethical guidelines, albeit never absolute, provide some degree of transparency, strength in shared decision-making, and cognitive clarity to alleviate the potential moral distress faced by trainees and others in this defining public health crisis of our time.

show abstract

“…We suggest trainees become familiar with guidelines put forth by institutions or national societies and, to the extent possible, become involved in their creation and revisions. These dynamic conversations will introduce trainees to ethical principles, because adequate policies balance principles of maximization of benefit, equal treatment of all patients, promotion of instrumental value without discrimination, and priority to the sickest and help trainees to be better advocates for patients and themselves ( 2 , 18 , 19 ). Furthermore, participating in this process as part of triage teams and frontline clinicians will provide trainees an opportunity to understand the rationale, to provide direct feedback based on personal experiences, and ultimately gain a greater sense of agency.…”

Section: The Importance Of Guidelines For Traineesmentioning

confidence: 99%