Ethical Challenges Experienced by Clinical Ethicists during COVID-19

Abstract

Background

The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Health care providers are exhausted, becoming ill themselves, and in some instances have died. Indeed, hospitals are struggling to find staff to care for critically ill patients most in need. Previous work has reported on the unending work-related conditions that hospital staff are laboring under and their subsequent mental and physical health strains. Health care providers need support, but it is not clear where that support is to come from. While much research has reported on the COVID-19-related fears of nurses and physicians, fewer studies have focused on supportive features of the hospital work environment and how it may provide relief to front-line health care providers.

Purpose

This purpose of this study was to explore an often-overlooked resource within hospital systems across the United States—clinical ethicists—and examine their many roles during COVID-19 and the types of ethical issues they addressed with nurses, physicians, administrators, and others.

Methods

This was a primary analysis of semi-structured, qualitative interviews with 23 clinical ethicists across the United States. The interviews were conducted from November 2020–April 2021 and were audiotaped, transcribed verbatim, and de-identified; both inductive and deductive analyses were used to identify qualitative themes.

Results

Five major themes were identified: ethical issues that were increasingly more complex, moral distress that was “endemic,” shifting ethical paradigms from the focus on the individual to the population, fostering a supportive environment, and organizational ethics: variation in the value, roles, and policy input of clinical ethicists.

Conclusions

Our findings report on the integral and expanded role of clinical ethicists at an unprecedented time in our nation, and how they stepped forward to support front-line clinicians in hospitals across the country.

Keywords:

• ethics
• clinical care
• ethicists
• COVID-19

Acknowledgement

The authors appreciate all the clinical ethicists who spoke to us and provided data for this project.

Access to data statement

The principal investigator had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure statement

The views expressed are those of the authors and do not necessarily reflect those of the Clinical Center, the National Institutes of Health, or the Department of Health and Human Services.

Additional information

Funding

Dr. Ulrich is partially supported by funding received from the Josiah Macy Jr. Foundation.