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The Hastings Center Produces Guidance for Ethical Practice in Responding to COVID-19

The Hastings Center has developed a resource for health care institutions and institutional ethics services to support leadership and practice during the novel coronavirus public health emergency and in the care of patients with COVID-19.

The Hastings Center convened an expert advisory group to meet the need for a practical resource to support institutional preparedness and supplement public health and clinical practice guidance on COVID-19. Nancy Berlinger, a research scholar at The Hastings Center, directed the rapid-response project, which was made possible by the Donaghue Impact Fund at The Hastings Center.

“This document provides a very practical set of recommendations to help guide actions from hospital and health system leaders in a very troubling time,” says Matthew Wynia, MD, MPH, a co-author of the new resource who is a professor in the Schools of Medicine and Public Health and directs the Center for Bioethics and Humanities at the University of Colorado, Anschutz Medical Campus. “Now is when ethical guidance is most valuable, and The Hastings Center has stepped up with a truly important contribution.” Wynia is also a Hastings Center fellow.

This resource includes an Ethical Framework to structure real-time discussion of significant, foreseeable ethical concerns arising under contingency levels of care and potentially crisis standards of care. It poses practical questions that administrators and clinicians may not yet have considered, and supports real-time reflection and review of policies and processes. It explains three duties of health care leaders during a public health emergency: to plan, safeguard, and guide.

The resource also offers detailed guidelines to help hospital ethics committees and clinical ethics consultation services quickly prepare to support clinicians providing care amid severe resource limitations.

“Shortages of staff, space, and stuff may lead to care restrictions, including but not limited to which patients are admitted to the ICU and receive life-sustaining treatments,” says Berlinger, the lead author of the new ethical framework and guidelines. “First come, first served is an unsatisfactory approach to allocating critical resources, yet it is difficult and distressing for clinicians accustomed to patient-centered care to change practice during a public health emergency. Our resource aims to help health care leaders and the health care workforce manage the unavoidable tension between the duty of care and duties to public health, including equality and equity.” Berlinger is also the lead author of the second edition of the Hastings Center Guidelines, the authoritative guide to treatment decision-making under normal health care conditions, and led The Hastings Center’s earlier work on pandemic planning.

“This practical resource is meant to provide health care organizations, clinicians, and ethicists with guidance for navigating this unprecedented time in our history,” said Aimee Milliken, RN, PhD, a co-author who is a clinical ethicist, nurse scientist, and director of research at Brigham and Women’s Hospital in Boston. “It includes an extensive list of important ethical topics and questions for consideration as response efforts are planned and implemented, with attention to the unique concerns of the bedside clinician. It will be of particular interest to nurses, especially in the critical care environment, who are, and will be, at the front lines of this pandemic.”

“This will be a useful and timely document in our current fearful circumstances,” says Tia Powell, MD, a co-author who directs of the Center for Bioethics and Masters in Bioethics at Montefiore Health Systems and Albert Einstein College of Medicine and a professor of epidemiology and psychiatry at Albert Einstein College of Medicine. Powell is also a Hastings Center fellow.

Berlinger adds: “Health care institutions are crucial to our society’s ability to withstand and recover from public health emergencies. Support for ethical practice is crucial to health care integrity and the well-being of the health care workforce. Recognizing and addressing the special challenges health care workers face in responding to COVID-19 is part of health care leadership and civic duty.”

The document is available for free on The Hastings Center’s website: Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19) Guidelines for Institutional Ethics Services Responding to COVID-19:Managing Uncertainty, Safeguarding Communities, Guiding Practice

A related resource is aimed at hospital ethics committees and clinical ethics consultation.