Ethical obligations for supporting healthcare workers during the COVID-19 pandemic

Supady, Alexander; Curtis, J. Randall; Brown, Crystal; Duerschmied, Daniel; Zepelin, Lyn Anne von; Moss, Marc; Brodie, Daniel

doi:10.1183/13993003.00124-2021

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…In some cases, due to their responsibility and commitment, healthcare workers may not be able to refuse medical treatment even if there is a shortage of PPE. Support from society is, therefore, essential as one-sided devotion of the healthcare workers alone will probably lead to failure [ 9 , 10 ]. The lack of PPE has already been shown to have a negative impact on the mental health of healthcare workers [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society

Kamada

Konno

Kaneko

et al. 2021

Respiratory Investigation

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Background The impact of the outbreak of COVID-19 on the work of respiratory physicians in Japan has not yet been evaluated. The study investigates the impact of the outbreak on respiratory physicians’ work over time and identifies problems to be addressed in the future. Methods We conducted a web-based survey of respiratory physicians in 848 institutions. The survey comprised 32 questions and four sections: Survey 1 (April 20, 2020), Survey 2 (May 27, 2020), Survey 3 (August 31, 2020), and Survey 4 (December 4, 2020). Results The mean survey response rate was 24.9%, and 502 facilities (59.2%) participated in at least one survey. The proportion of facilities that could perform PCR tests for diagnosis and more than 20 tests per day gradually increased. The percentage capable of managing extracorporeal membrane oxygenation (ECMO) or more than five ventilators did not increase over time. The proportion that reported work overload of 150% or more, stress associated with lack of personal protective equipment (PPE), and harassment or stigma in the surrounding community did not sufficiently improve. Conclusion While there was an improvement in expanding the examination system and medical cooperation in the community, there was no indication of enhancement of the critical care management system. The overwork of respiratory physicians, lack of PPE, and harassment and stigma related to COVID-19 did not sufficiently improve and need to be addressed urgently.

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Section: Discussionmentioning

confidence: 99%

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society

Kamada

Konno

Kaneko

et al. 2021

Respiratory Investigation

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“…Participants primarily described experiencing distress from an inability to prognosticate and guide family members due to the uncertainty of the pandemic, as well as from witnessing the plight of colleagues on the ground, suggesting that providers feel an ethical obligation to help fellow healthcare workers during a time of need. 24 Of note, much of the participants' moral distress stemmed from the conflict between the conditions of scarcity created by the pandemic and a core tenet of palliative medicine, which is to engage openly and honestly with patients and family without an agenda. However, the meaning and fulfillment derived from the ability to help patients, patients' loved ones, and colleagues ultimately seemed to outweigh their emotional burden.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of Remote Volunteer Palliative Care Consultants During COVID: A Qualitative Study

Tong

Kapur

Fleet

et al. 2022

Journal of Pain and Symptom Management

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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.

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“…During a pandemic, availability of intensive care resources including ECMO may not meet demand [ 84 ]. This may pertain to structural resources (e.g., ICU beds, ventilators, dialysis machines or ECMO consoles), consumables (e.g., specific drugs, ECMO equipment, including membrane lungs, tubing or cannulae), and also human resources (e.g., physicians, nurses and other essential clinical personnel) [ 85 ]. Ultimately, rationing and prioritization of scarce resources may be required [ 17 , 86 ].…”

Section: Organization Of Ecmo Systems and Implications Of Resource Li...mentioning

confidence: 99%

Respiratory indications for ECMO: focus on COVID-19

et al. 2022

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Extracorporeal membrane oxygenation (ECMO) is increasingly being used for patients with severe respiratory failure and has received particular attention during the coronavirus disease 2019 (COVID-19) pandemic. Evidence from two key randomized controlled trials, a subsequent post hoc Bayesian analysis, and meta-analyses support the interpretation of a benefit of ECMO in combination with ultra-lung-protective ventilation for select patients with very severe forms of acute respiratory distress syndrome (ARDS). During the pandemic, new evidence has emerged helping to better define the role of ECMO for patients with COVID-19. Results from large cohorts suggest outcomes during the first wave of the pandemic were similar to those in non-COVID-19 cohorts. As the pandemic continued, mortality of patients supported with ECMO has increased. However, the precise reasons for this observation are unclear. Known risk factors for mortality in COVID-19 and non-COVID-19 patients are higher patient age, concomitant extra-pulmonary organ failures or malignancies, prolonged mechanical ventilation before ECMO, less experienced treatment teams and lower ECMO caseloads in the treating center. ECMO is a high resource-dependent support option; therefore, it should be used judiciously, and its availability may need to be constrained when resources are scarce. More evidence from high-quality research is required to better define the role and limitations of ECMO in patients with severe COVID-19.

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Ethical obligations for supporting healthcare workers during the COVID-19 pandemic

Cited by 10 publications

References 13 publications

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society

Perspectives of Remote Volunteer Palliative Care Consultants During COVID: A Qualitative Study

Respiratory indications for ECMO: focus on COVID-19

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