My fear, my morals: a surgeon’s perspective of the COVID crisis

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Thirteen articles (22.8%) described situations where some HCWs were unable to work to the same extent as their colleagues on the frontlines, representing samples from the Americas ( n = 8) ( 46 , 50 , 52 – 54 , 78 – 80 ), South-east Asia (n = 2) ( 67 , 68 ), and one article each from Africa ( 81 ), Europe ( 56 ), and Western Pacific ( 82 ). These situations were described by some HCWs to be associated with feelings of guilt and shame ( 50 , 52 , 53 , 56 , 78 , 81 , 82 ).…”

“…Feelings of guilt were reported by HCWs who felt that they did not have the same level of exposure or risk as their colleagues, including surgeons ( 52 , 67 ) (United States, India), radiologists ( 46 ) (North America), students ( 54 ) (United States), and other HCWs not assigned to work in-person, or who chose to switch to telemedicine due to underlying comorbidities ( 50 , 54 , 79 , 80 ) (United States). Similar feelings were reported by HCWs who were required to isolate and quarantine following exposure or infection by COVID-19 ( 53 , 56 , 82 ) (Ireland, Vietnam, and United States).…”

“…Given an early lack of clinical guidelines and evidence surrounding COVID-19, HCWs described difficulty deciding on and communicating an appropriate therapeutic course of action and a realistic prognosis in many cases ( 48 , 51 , 53 , 81 , 83 ) (United States, South Africa). Thirty-three articles (57.9%) discussed the idea of providing suboptimal care, representing diverse samples across the globe, including the Americas ( n = 15) ( 7 , 11 , 48 – 54 , 83 – 88 ), Europe ( n = 9) ( 56 – 58 , 60 – 62 , 89 – 91 ), Western Pacific ( n = 3) ( 70 , 72 , 92 ), Eastern Mediterranean ( n = 2) ( 74 , 93 ), South-east Asia ( n = 2) ( 67 , 94 ), and one from Africa ( 81 ) and another with a global scope ( 44 ). From these articles, three subcategories were formed: “PPE negatively impacting care”; “Inability to provide a good death”; and “Unprepared for novel tasks.” HCWs drew connections between providing suboptimal care or seeing patients dying alone and feelings of guilt ( 50 , 54 , 74 ), sorrow ( 11 , 51 ), worry ( 70 , 88 ), and powerlessness ( 72 , 84 ).…”

“…Eight studies across the Americas ( n = 4) ( 49 , 51 , 53 , 83 ), Europe ( n = 2) ( 58 , 89 ), South-east Asia ( n = 1) ( 67 ), and Western Pacific ( n = 1) ( 70 ), described how the use of PPE by HCWs acted as a significant physical and emotional barrier to patient care. The use of PPE and the need for distancing made it difficult to verbally communicate with patients ( 49 , 58 , 89 ) (United Kingdom, Canada, Belgium) and convey emotion, with some HCWs reporting that the use of PPE increased fear in patients ( 49 , 51 , 53 , 70 , 89 ) (Canada, United States, China, United Kingdom).…”

“…Another factor that may have limited HCWs’ ability to provide optimal care was the lack of preparation for novel tasks beyond the scope of their role. Nineteen articles described the events of participants from the Americas ( n = 6) ( 7 , 48 , 49 , 51 , 54 , 83 ), Europe ( n = 8) ( 57 , 58 , 60 – 62 , 89 – 91 ) South-east Asia ( n = 2) ( 67 , 94 ), Western Pacific ( n = 2) ( 70 , 72 ), and globally ( n = 1) ( 44 ). Many HCWs were redeployed during the pandemic to assignments where they took on unfamiliar roles—junior doctors were now regularly breaking bad news ( 89 ) (United Kingdom), allied health professionals assisted in kitchen and nursing tasks ( 58 ) (Belgium), and pediatric ICU providers cared for adult patients ( 90 ) (United Kingdom).…”