Dying during Covid‐19

Abstract

I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, “You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her.” Madeleine, who was twenty‐four years old, was dying of end‐stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical treatment—in my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid‐19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients’ and families’ experiences at the end of life during a pandemic .

Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19

“…While there have been compassionate attempts to allow visitors for dying patients, social distancing has led inevitably to loss of a sense of control and to anxiety, challenging the ability to cope with the death of a loved one. 1,10 The worry and guilt associated with inability to offer loving presence and companionship for their loved ones have been expressed frequently by distressed families and may increase the risk for complicated grief. 4 Reports from across the country describe in heart-breaking detail the plight of families saying their last good-byes to a loved one via technology or through glass or plastic barriers and their limited ability to comfort dying loved ones with their touch, hug, or kiss.…”

“…4 Reports from across the country describe in heart-breaking detail the plight of families saying their last good-byes to a loved one via technology or through glass or plastic barriers and their limited ability to comfort dying loved ones with their touch, hug, or kiss. 1 Joy Miller, PhD, founder of Resiliency 2020, has said, "COVID-19 robbed us of our goodbyes." 22 Grief rituals have been adapted to comply with the requirements of social distancing, 23,24 nevertheless, physical separation and social distancing during bereavement can cause significant distress.…”

Family Presence for Critically Ill Patients During a Pandemic

“…17 This is undoubtedly exacerbated in the setting of family separation around the time of death, due to incomplete grief resulting from health-care system limits on the opportunities of families to carry out mourning rituals, or doing so in an abbreviated or delayed manner. 4,15,17 Prohibiting family presence is likely to further strain the ICU workforce in the short and long term. 27 Physicians may experience secondary trauma and moral injury due to participating in separation of families during critical illness and death, which has been widespread during the COVID-19 pandemic.…”

“…8,9 Although such restrictions were reasonable in the early periods of limited scientific knowledge about viral transmission, supply shortages, and rapid efforts to restructure hospitals to expand capacity, 10 reevaluation of these policies is now critical given our increased information and resources. [11][12][13] ICU visitation restrictions such as those enacted because of COVID-19 lead to incomplete grief (eg, inability to fully experience the grieving process) 11, [14][15][16][17][18] ; emotional distress experienced by patients, families, and physicians 11, [14][15][16][17][18][19][20][21][22][23] ; barriers to high-quality communication and decision-making 11, [14][15][16][17][18][19][20][21][22]24 ; perpetuation of existing inequities 11,20 ; and poor clinical outcomes. 11,14,[17][18][19][20][24][25][26] Given the serious and longlasting harm these restrictions cause for patients, family members, staff, and communities, we believe broadly prohibiting visitation of family members of patients with critical illness, including those with COVID-19, is no longer justified.…”

Empathy-Based Ethics in Medical Practice

“…Other mental health problems arising from prolonged isolation include addiction, domestic violence and post-traumatic stress disorder (Roy et al 2020). Grieving in isolation may be prolonged for families unable to visit their dying relative (Moore 2020).…”