Not Dying Alone: the Need to Democratize Hospital Visitation Policies During Covid-19

Abstract

Of the many adverse outcomes that may result from the spread of the severe acute respiratory syndrome coronavirus 2, known as COVID-19, one stands out as particularly vile: the experience of dying alone. Many healthcare facilities in the US and elsewhere adopted ‘No-Visitor Rules’ in an effort to contain the virus, but these rules mean that the countless people in nursing homes and hospital wards were isolated during their final hours of life. There is no epidemiological or US federal or state requirement to prohibit visitation to (and thereby isolate) dying patients—even those with COVID-19. Instead, constructing pandemic-specific visitation policies is usually left to the discretion of hospitals and healthcare providers. Such policies aim to limit the risk of exposure but fail to account for the individual and social costs associated with dying alone for patients, families, and frontline healthcare workers. As a result, the policies may be overly restrictive and actively cause harm. This article argues that US hospital visitation policies need to be democratised to include the perspectives of community members and patients. By drawing on existing patient rights frameworks, this article outlines several legal strategies to reconceptualise hospital visitation policies as a civil rights issue.

Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada

“… 34–37 For hospital administrative policy development, there is the ethical challenge of balancing the patient and family need for in-person contact at end-of-life against the measures to reduce infection risk with COVID-19, 13 38 in addition to legal considerations. 38 …”

“…There are many reports of moral distress in physicians and nurses during the pandemic; caring for patients dying alone without any family present is cited as a major contributor to this 34–37. For hospital administrative policy development, there is the ethical challenge of balancing the patient and family need for in-person contact at end-of-life against the measures to reduce infection risk with COVID-19,13 38 in addition to legal considerations 38…”

Relatives Experience More Psychological Distress Due to COVID-19 Pandemic-Related Visitation Restrictions Than In-Patients

“…In end-of-life care, limiting visits or prohibiting visits resulted in inadequate emotional and spiritual care/support for patients and anxiety and despair among family members ( 22 , 23 ). Patients were afraid of dying alone ( 24 ). In patients in the postoperative period, VR affected satisfaction with the hospital experience, and patients without visitors reported social isolation due to a lack of psychosocial support ( 25 ).…”

“…It is known that inadequate information is a stressor for negative psychological effects such as posttraumatic stress symptoms, confusion, and anger ( 26 ). Furthermore, relatives feel helpless and guilty, because they cannot support their beloved ones ( 24 ). In addition, due to the extensive Corona protection measures, the relatives were exposed to additional restrictions (e.g., quarantine, contact blocks, and distance regulations) in everyday life, which have direct negative psychological consequences ( 11 , 12 , 26 , 27 ).…”

“…In end-of-life care, limiting visits or prohibiting visits resulted in inadequate emotional and spiritual care/support for patients and anxiety and despair among family members (22,23). Patients were afraid of dying alone (24). In patients in the postoperative period, VR affected a On a scale from 0 (none) to 100 (extreme), the psychological distress resulting from the visit restriction is on average 40 ± 32.…”