Until now, little has been published about the expanded role clinical ethicists played during the COVID-19 pandemic – which brought many troubling ethical issues to the frontlines of clinical care, creating significant distress for clinicians, patients and families – and their role in supporting hospital operations.
A study from the University of Pennsylvania School of Nursing (Penn Nursing) reports how clinical ethicists, behind the scenes, were integral to hospital operations, providing consultation and guidance in situations of uncertainty, distress, or disagreement, often with imperfect information, and how they managed those issues to support frontline workers.
“Although the clinical ethicists’ role has been studied under usual circumstances, very little is understood about their experience during the pandemic, the ethical challenges they faced, and how they addressed their own ethical challenges or received support,” says the study’s lead investigator, Connie Ulrich, PhD, RN, FAAN, Lillian S Brunner Chair in Medical and Surgical Nursing, Professor of Nursing and Professor of Medical Ethics and Health Policy at Penn Nursing. The study was published in the journal AJOB Empirical Bioethics.
“By understanding their experiences during that time and the ethical challenges they faced, we can better understand how their expanded role links to both clinical and organisational outcomes,” says Ulrich. “Moreover, it is important to know whether this role has now moved beyond traditional conceptions and the resulting future educational needs.”
Study details
Ethical Challenges Experienced by Clinical Ethicists during COVID-19.
Connie Ulrich, Janet Deatrick, Jesse Wool, Liming Huang, Nancy Berlinger, Christine Grady.
Published in AJOB Empirical Bioethics on 22 August 2022.
Abstract
Background
The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Healthcare 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 labouring 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 healthcare 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 US. 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 organisational 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.
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