Covid 19 and Treatment access
The Care Quality Commission (CQC) interim review (2020), has found unacceptable and inappropriate ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) notices were made at the start of the COVID-19 pandemic. The findings come after the CQC raised concerns that older and vulnerable people may have had DNACPR decisions made without their consent or may have made them without enough details for an informed decision (Hackett, 2020). This is a sensitive question at the best of times. But consent is a precious right for all patients and to obtain it is a skill required of nurses (and doctors) with each patient admission where appropriate and possible. One example of the pressure and confusion during the early days of the pandemic, the CQC noted that guidance intended to help clinicians assess frailty as part of a wider, holistic assessment around the appropriateness of critical care, may have been interpreted as the sole basis for clinical decisions in some instances.
Coronavirus demands on the NHS resources are outstripping supply and those responsible for our care and well-being are facing challenging decisions. What may well be on all our minds is what provision will be available if I, or a loved one, is in need of treatment and life-support in these circumstances. While we would all agree that the allocation of resources must be done, as fairly, as possible, the criteria of fairness must be clear and shared by us all. These principles apply both morally and in law, which governs our expectations and rights on health and social care.As Christians our starting point is that we are all made equally in the image of God. Human value is not a measure of our mental or physical capacity, our societal function, our age, our health or of any other qualitative assessment. God made each of us and in so doing gave us all equal dignity and value. This is never lost during sickness or dying.It is important to bear in mind in any discussion of resource allocation and medical rationing when the tension between the appropriate treatment and scarcity of resources has, in most people’s experience, never been so visible.
A decision against offering a certain life-prolonging treatment to an individual must never be a judgement based on the worthwhileness of that person’s life, including their age or other social characteristics, but a pragmatic decision about the likelihood of him/her benefiting from the intervention given their medical condition. This principle has been upheld in case law repeatedly and the NHS Constitution itself is clear that we should deliver care and support in a way that achieves dignity and compassion for each and every person we serve. Until the current pandemic, resources have always been allocated according to medical need and benefit to the patient. Today this approach must be complemented by maximising scarce resources for the common good and so prognosis, and the likelihood of benefit becomes the overriding criteria.
People with underlying health conditions should discuss the sort of treatment they may want with their families so that good communication is possible in a crisis. Each of us may be presented with clinical scenarios which are both unwelcome and distressing, yet doctors are faced with making the least-worst decisions. This approach helps us to focus on the common good. Similarly, Catholics will focus on the benefit of a particular treatment for the person taking into consideration all medical factors. This, again, helps us to focus on the common good of all and best meets the principles of justice and equality (Moth et al, 2020). It has been argued further that the miseries for the elderly in their care homes, to ensure their safety from Covid 19, being unable to see even one of their family members, for visits, should be weighed against the need for love and compassion.
It has been realised how hard it is for the elderly in care to be without visitors, so a pilot study of one named relative being allowed to visit with regular testing, is being initiated. Every last precautionary measure of infection prevention… “should not trump the deaths in loneliness of tens of thousands. When the elderly people are no longer with us, due to their deaths by Covid 19, we shall look back on how we treated the institutionalised elderly in this year of Covid 19 and be ashamed” (Parris, 2020). This criticism cannot overlook, however, those dedicated staff, the Good Samaritans, who tried their very best to care for the vulnerable elderly in care homes which involved being apart from their own families to protect their residents from the risk of Covid 19.
Hackett, K. (2020). DNACPR notices: review finds ‘unacceptable and inappropriate’ use early in pandemic. Care Quality Commission says older and vulnerable people most at risk. Nursing Standard, 4 December.
Moth, R., Mason, P., Sherrington, J. (2020). Coronavirus and Access to Treatment, RCDOW. Monday, April 20th, 2020 @ 1:10 pm
Parris, M. (2020). It’s shameful how we have treated our elderly. The Spectator. 14 November.
ANSCOMBE BIOETHICS CENTRE
Baby Charlie Gard dies. Latest ethical analysis – clash of interests: life and death. July 29th 2017:
The Anscombe Bioethics Centre (Oxford, 2017) press statement, entitled: “Doing the right thing for the right reasons” presents a well-balanced ethical analysis, see the following link:
The Conversation: Should euthanasia be available for people with existential suffering? (with acknowledgements to BioEdge, see the following link) :
ROYAL COLLEGE OF NURSING: END OF LIFE CARE
The term ‘end of life’ usually refers to the last year of life, although for some people this will be significantly shorter. The term palliative care is often used interchangeably with end of life care. However, palliative care largely relates to symptom management, rather than actual end of life care.
The RCN believes that end of life care is not just the responsibility of specialist nurses and teams, rather that everyone should be able to care for a loved one as they reach the end of their lives, including all nurses and health care support workers in all settings, the patient’s family as well as members of the community.
End of life care is not just the practical and technical delivery of care provided to the individual who is dying, but also refers to the support and information available both to them and the people who are important to them, e.g. bereavement support.
Due to an unacceptable variance in the availability of services and professional expertise available to patients, many people are experiencing poor care at a time when they and their families need it to be at its best. The RCN is committed to ensuring that nurses working with people who are dying are given the support they need to understand their role. See the following link for more detail:
UK: End of life care competencies set out in a new framework:
Catholic Bishops of England and Wales: Website and interviews : http://artdying well.org
Skills for health : End of Life Care
Nutrition and hydration: https://www.bmj.com/content/346/bmj.f801.full
Royal College of Nursing : https://www.rcn.org.uk/professional-development/publications/pub-004871
Spirituality Survey (RCN: 2010)
A guide to Spirituality for Catholic Nurses:
The complexity of nurses’attitudes toward euthanasia: a review of the literature
CHRONIC CONDITIONS: A rapid synthesis of the evidence on interventions supporting
self-management for people with long term conditions. Health Services and
Delivery Research, Taylor et al. (2014) 2(53) pp.1-580. Available via the link:
Challenging Medical Ethics: Two books by Dr Gill Craig:
Lord, when did we see you sick? A Journey with the Sick by a Hospital Chaplain.
Author: Father Michael Stack.
To access the above books, please email: [email protected]
- Wesley J Smith (2016) “Culture of Death: The Age of ‘Do Harm’ Medicine“:
This story is one of many, Wesley J. Smith recounts in his award-winning classic critique of the modern bioethics movement, Culture of Death. In this newly updated edition, Smith chronicles how the threats to the equality of human life have accelerated in recent years, from the proliferation of euthanasia and the Brittany Maynard assisted suicide firestorm, to the potential for death panels posed by Obamacare and the explosive Terri Schiavo controversy. Culture of Death reveals how more and more doctors have withdrawn from the Hippocratic Oath and how bio ethicists influence policy by posing questions such as whether organs may be harvested from the terminally ill and disabled. This is a passionate yet coolly reasoned book about the current crisis in medical ethics by an author who has made â€œthe new thanatology his consuming interest.
Wesley J Smith (2006):Forced Exit: Euthanasia, Assisted Suicide and the New Duty to Die.
Filled with new reporting and research, this expanded edition of a classic book makes a compelling case against legalized euthanasia and takes a closer look at the truly humane and compassionate alternatives.
- Fear and False Promises: The Challenge of Pain in the Terminally Ill (1995). Dr John Scott.
(In : EUTHANASIA AND ASSISTED SUICIDE (1995): The Current Debate, ed. Ian Gentles. Toronto. Stoddart Books) .
PALLIATIVE CARE :
Nursing Innovation: A Nursing project to improve the care of people at the end of life by emphasising patient experience, has selected 19 teams to join.
‘The Point of Care Foundation’, an independent charity, in 2016, supported eight teams on its
‘Living Well to the Very End’ programme (LWVE). The new cohort of multi-disciplinary healthcare
teams is funded by the Health Foundation and supported by NHS England. Oxford University
Hospital NHS Foundation Trust ward sister, Frances Riley was involved in the LWVE programme
in 2016. Her ward made a number of practical changes, including:
Drawing up an updated written procedure, drafted and owned by ward nurses, for the care of each patient’s body after death.
Ensuring nurses attend regular meetings with families and doctors when end of life care is discussed.
Providing training on end of life medication and syringe drivers for nursing staff, with prompts to ensure early prescribing.
Sending a sympathy card from ward staff to family members on the death of a patient, with a personalised message from the nurse who cared for the patient.
Ms Riley said that being involved in the project had given her ward a good opportunity to focus on end of life care.˜We spent every week of the year doing it, and trying to achieve it has really meant something to the ward.
Ms Riley said one challenge had been engaging doctors in the process.˜We are a nurse-led team and it has been difficult to get the doctor’s involvement in some of the care we give and getting them to help us with our decision making. Ms Riley advises new LWVE teams to allow themselves plenty of time and emphasised how important regular weekly or bi-weekly meetings had been to the project’s success.The Point of Care Foundation head of improvement Bev Fitzsimons said: “The great thing about this programme is that many of the improvements that are beneficial to patients do not take significant time or money for staff to implement. “The changes we see look simple, but it is only by having the time to take a step back that staff can notice seemingly small things, such as practical aspects that add stress at an already difficult time.These are incredibly important changes that can be underestimated when outcome measures focus on clinical care.
Read more on this initiative: https://rcni.com/nursing-standard/newsroom/news/new-teams-chosen-end-of-life-care-project-85546
Changing Practice in Health and Social Care. Davies C . (2000) This is a set book for the Open University course K302 Critical Practice in Health and Social Care
Topics examined include: accountability to service users, funders and communities; the skills needed for teamwork and collaboration; and ethical dilemmas of working in conditions of resource constraint, and engaging in questions of quality and performance review. The chapters reflect the similarities and differences between the NHS and social services
VIDEOS you might like to watch:
The Mother Situation – Black Australian ‘comedy’ on ‘Assisted Suicide’ :
Ethics Workshop Part 1 -3 Â Overview of Moral Reasoning and Ethical Theory, Shannon French, PhD.