Phases of a Pandemic Surge: The Experience of an Ethics Service in New York City during COVID-19

Huberman, Barrie J.; Mukherjee, Debjani; Gabbay, Ezra; Knowlton, Samantha; Green, Douglas S. T.; Pandya, Nekee; Meredith, Nicole; Walker, Joan; Shapiro, Zachary E.; Hersh, Jennifer; Chisholm, Mary F.; Waldman, Seth A.; MacKenzie, C. Ronald; Melo‐Martín, Inmaculada de; Fins, Joseph J.

doi:10.1086/jce2020313219

Cited by 12 publications

(4 citation statements)

References 7 publications

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“…The second case demonstrates how telephonic nurses can assist hospitalized patients and families with understanding complex clinical scenarios and promoting goal-concordant care. During the COVID-19 surge, EDs were overwhelmed, and patients and families were not allowed to be at their loved ones' bedsides 42 . The older adults were left isolated and alone in EDs without anyone to advocate for them 43 .…”

Section: Discussionmentioning

confidence: 99%

“…During the COVID-19 surge, EDs were overwhelmed, and patients and families were not allowed to be at their loved ones' bedsides. 42 The older adults were left isolated and alone in EDs without anyone to advocate for them. 43 The time for detailed goals-of-care conversations, which are difficult in the ED during the best of times, was often impossible.…”

Section: Advance Care Planningmentioning

confidence: 99%

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Nurse-Led Telephonic Palliative Care

Yamarik

Tan

Brody

et al. 2022

J Hosp Palliat Nurs

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Americans near the end of life experience high rates of nonbeneficial, burdensome, and preventable hospital-based care. If patients' goals of care are unknown or unclear, they have higher rates of hospitalization at the end of life. The demand for palliative care has grown exponentially because of its impact on quality of life, symptom burden, and resource use, requiring the development of new palliative care models. Nurses' holistic outlook and patient-centered focus make them ideal to deliver telephonic palliative care. This article discusses 4 cases delivered by a nurse-led telephonic palliative care program, a part of the Emergency Medicine Palliative Care Access project, which is a randomized controlled trial comparing outpatient palliative care with nurse-led telephonic case management after an emergency department visit. Telephonic nurses discuss patients' goals, fears, hopes, and concerns regarding their illness and its trajectory that inform decisions for future interventions and treatments. In addition, they share this information with the patients' surrogate decision-makers and clinicians to facilitate care coordination and symptom management. For seriously ill patients, nurses' abilities and expertise, as well as the difficulties of providing care through in-person models of palliative care delivery, make a nurse-led telephonic model an optimal option.

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Section: Discussionmentioning

confidence: 99%

Section: Advance Care Planningmentioning

confidence: 99%

Nurse-Led Telephonic Palliative Care

Yamarik

Tan

Brody

et al. 2022

J Hosp Palliat Nurs

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“…My take will be refracted through my experience responding to the Spring surge in New York: First, as a member of the New York State Task Force on Life and the Law and second, as a physician-ethicist leading an ethics consultation service at a major academic medical center during those horrible weeks in 2020 (Fins & Prager, 2020; Huberman et al, 2020; Prager & Fins, 2020). My methodology is informed by the great American pragmatist John Dewey and his notion of learning by doing (Miller et al, 1996).…”

Section: Learning From the Surgementioning

confidence: 99%

Is deliberative democracy possible during a pandemic? Reflections of a bioethicist.

Fins¹

2021

Journal of Theoretical and Philosophical Psychology

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In 1985, Governor Mario Cuomo established the New York State Task Force on Life and the Law to provide guidance on issues at the interface of medicine, ethics and the law. During its tenure, the Task Force has been the leading state-based commission in this space producing landmark reports on end-of-life care, physician-assisted suicide, genetic testing, newborn care, brain death, surrogate decision making, assisted reproduction, and ventilator allocation in pandemic flu. These documents have informed state policy, both regulatory and statutory, and had an outsized influence on policy deliberation nationwide. Despite this notable provenance, the Task Force was missing in action during the coronavirus disease 2019 (COVID-19) pandemic. Although individual members were sought for consultation, the Task Force as a whole did not meet during the entirety of the pandemic. This article will explore the consequences of this omission and argue that as a deliberative body, the Task Force should have been an essential component of statewide debate on questions of crisis standards of care, health equity, and vaccine allocation. The COVID-19 experience exposed weaknesses in New York's process of deliberative democracy in response to the pandemic. A state with a distinguished history in this interdisciplinary space was left behind with the views of important constituencies left unheard and communities unserved. Better apprehending how this abdication of responsibility occurred. Public Significance StatementThis has public policy significiance as it can help prevent its recurrence in the future and lead to more trustworthy, inclusive and effective public health and health law governance.

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“…To assist in these challenging decisions, some institutions have built dedicated services for deliberating the probability of neurologic recovery (i.e., coma boards 7 ) and have used ethics consultations. 8 However, the uncertain prognosis of COVID-DoC raises the alarming possibility of error in decisions about life-sustaining treatment: continuation for patients with little chance of meaningful recovery or withdrawal for patients who would have otherwise recovered.…”

mentioning

confidence: 99%

Disorders of Consciousness Associated With COVID-19

et al. 2022

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Background and Objectives:In patients with severe coronavirus disease 2019 (COVID-19), disorders of consciousness (COVID-DoC) have emerged as a serious complication. The prognosis and pathophysiology of COVID-DoC remain unclear, complicating decisions about continuing life-sustaining treatment. We describe the natural history of COVID-DoC and investigate its associated brain connectivity profile.Methods:In a prospective, longitudinal study, we screened consecutive patients with COVID-19 at our institution. We enrolled critically ill adult patients with a DoC unexplained by sedation or structural brain injury, and who were planned to undergo a brain MRI. We performed resting state functional MRI and diffusion MRI to evaluate functional and structural connectivity, as compared to healthy controls and patients with DoC resulting from severe traumatic brain injury (TBI). We assessed the recovery of consciousness (command-following) and functional outcomes (Glasgow Outcome Scale Extended [GOSE] and the Disability Rating Scale [DRS]) at hospital discharge, three months post-discharge, and six months post-discharge. We also explored whether clinical variables were associated with recovery from COVID-DoC.Results:After screening 1,105 patients with COVID-19, we enrolled twelve with COVID-DoC. The median age was 63.5 years [interquartile range 55-76.3]. Excluding one who died shortly after enrollment, all of the remaining eleven patients recovered consciousness, after 0-25 days (median 7 [5-14.5]) following the cessation of continuous intravenous sedation. At discharge, all surviving patients remained dependent – median GOSE 3 [1-3], median DRS 23 [16-30]. However ultimately, except for two patients with severe polyneuropathy, all returned home with normal cognition and minimal disability – at three months, median GOSE 3 [3-3], median DRS 7 [5-13]; at six months, median GOSE 4 [4-5], median DRS 3 [3-5]. Ten patients with COVID-DoC underwent advanced neuroimaging; functional and structural brain connectivity in COVID-DoC was diminished compared to healthy controls, and structural connectivity was comparable to patients with severe TBI.Discussion:Patients who survived invariably recovered consciousness after COVID-DoC. Though disability was common following hospitalization, functional status improved over the ensuing months. While future research is necessary, these prospective findings inform the prognosis and pathophysiology of COVID-DoC.Trial Registration Information:Clinicaltrials.gov, NCT04476589, submitted 7/2020, first enrolled 7/20/2020, https://clinicaltrials.gov/ct2/show/NCT04476589

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Phases of a Pandemic Surge: The Experience of an Ethics Service in New York City during COVID-19

Cited by 12 publications

References 7 publications

Nurse-Led Telephonic Palliative Care

Nurse-Led Telephonic Palliative Care

Is deliberative democracy possible during a pandemic? Reflections of a bioethicist.

Disorders of Consciousness Associated With COVID-19

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