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

Autor:	Huberman BJ; Interim Assistant Professor of Medical Ethics in Clinical Medicine and Clinical Director of the Division of Medical Ethics at Weill Cornell Medical College; and Clinical Director of Medical Ethics and Senior Clinical Ethicist at New York Presbyterian Weill Cornell Medicine in New York, New York USA. bjh4001@med.cornell.edu., Mukherjee D; Interim Assistant Professor of Medical Ethics in Clinical Medicine and in Clinical Rehabilitation Medicine at Weill Cornell Medical College; and Associate Clinical Ethicist at New York Presbyterian Weill Cornell Medicine in New York, New York USA. dem9199@med.cornell.edu., Gabbay E; Assistant Professor of Medicine in the Divisions of General Internal Medicine (Hospital Medicine Section) and Medical Ethics in Medicine at Weill Cornell Medical College; and Associate Clinical Ethicist at New York Presbyterian Weill Cornell Medicine in New York, New York USA. ezg9002@med.cornell.edu., Knowlton SF; Clinical Assistant Professor of Medical Ethics in Medicine in the Division of Medical Ethics at Weill Cornell Medical College; and Associate Clinical Ethicist at New York Presbyterian Weill Cornell Medicine in New York, New York USA. sfk2002@med.cornell.edu., Green DST; Clinical Assistant Professor of Anesthesiology at Weill Cornell Medical College; and an Attending Anesthesiologist in the Department of Anesthesiology, Critical Care, and Pain Management at Hospital for Special Surgery in New York, New York USA. greendo@HSS.edu., Pandya N; Assistant Professor of Medicine and Clinical Ethics Fellow at Weill Cornell Medical College; and Attending Physician in the Division of General Internal Medicine (Hospital Medicine Section) at New York-Presbyterian Weill Cornell Medicine in New York, New York USA. nep9024@med.cornell.edu., Meredith N; PGY-4 General Surgery Resident at New York Presbyterian Weill Cornell Medicine and recently completed her Clinical Ethics Fellowship at Weill Cornell Medical College in New York, New York USA. nam9121@nyp.org., Walker JM; Lecturer of Medical Ethics in Medicine and Administrative Director, Division of Medical Ethics, Weill Cornell Medical College; and an Associate Clinical Ethicist at New York Presbyterian Weill Cornell Medicine in New York, New York USA. jow9033@ med.cornell.edu., Shapiro ZE; Postdoctoral Fellow in the Division of Medical Ethics at Weill Cornell Medical College in New York, New York USA. Zas4001@med.cornell.edu., Hersh JE; Research Coordinator for the Division of Medical Ethics at Weill Cornell Medical College in New York, New York USA. jeh2015@med.cornell.edu., Chisholm MF; Clinical Assistant Professor of Anesthesiology and Clinical Assistant Professor of Medical Ethics in Medicine at Weill Cornell Medical College; an Associate Clinical Ethicist at New York Presbyterian Weill Cornell Medicine; and Assistant Attending Anesthesiologist, Department of Anesthesiology, Critical Care and Pain Management at Hospital for Special Surgery in New York, New York USA. mac2085@med.cornell.edu., Waldman SA; Director of the Division of Pain Management, the C.V. Starr Endowed Chair in Pain Management, and Attending Physician in the Department of Anesthesiology, Critical Care, and Pain Management at Hospital for Special Surgery; Clinical Assistant Professor of Anesthesiology and Pain Management at Weill Cornell Medical College; and Assistant Medical Ethicist at New York Presbyterian Weill Cornell Medicine in New York, New York USA. waldmans@hss.edu., MacKenzie CR; C Ronald MacKenzie Chair in Ethics and Medicine and Attending Physician at Hospital for Special Surgery; Professor of Clinical Medicine at Weill Cornell Medical College; and Attending Physician at New York Presbyterian Weill Cornell Medicine in New York, New York USA. mackenzier@hss.edu., de Melo-Martín I; Professor of Medical Ethics in Medicine, Professor of Medical Ethics in Reproductive Health, and Professor of Healthcare Policy and Research at Weill Cornell Medical College in New York, New York USA. imd2001@med.cornell.edu., Fins JJ; William E. Davis, Jr., MD Professor of Medical Ethics, Professor of Medicine, and Chief of the Division of Medical Ethics at Weill Cornell Medical College; and is Director of Medical Ethics and an Attending Physician at New York Presbyterian Weil Cornell Medicine in New York, New York USA. jjfins@med.cornell. edu.
Jazyk:	angličtina
Zdroj:	The Journal of clinical ethics [J Clin Ethics] 2020 Fall; Vol. 31 (3), pp. 219-227.
Abstrakt:	When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (Copyright 2020 The Journal of Clinical Ethics. All rights reserved.)
Databáze:	MEDLINE
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