As the COVID-19 pandemic began to escalate across the U.S., Mark Aulisio joined the first of many teleconferences with MetroHealth Medical Center’s pandemic working group to plan for how they would allocate scarce resources in a crisis that was beginning to seem inevitable.
Aulisio, the Susan E. Watson Professor and chair of Case Western Reserve University School of Medicine’s Department of Bioethics, participated in three weeks of daily meetings with clinicians, attorneys and hospital administrators to begin thinking through critical questions they might face before the issues actually arose within MetroHealth. They considered factors like age, prioritization of health care workers, the risks and benefits of CPR, and the use of split ventilators as a measure of last resort.
“The goal was to come up with a way of making resource allocation decisions that were ethically defensible, but also clinically workable,” said Aulisio, who also serves as MetroHealth’s director of clinical bioethics. “We’re usually primarily thinking about autonomy, general informed consent, shared decision-making and so on. But in the case of an overwhelming surge that demands ICU resources, you have to think about how you’re going to use the limited resources you have, and that’s a very different approach.”
Planning for the worst-case scenario has offered bioethicists a unique and sobering perspective into how the virus can affect every aspect of patient care, even for those who haven’t tested positive. Aulisio, along with other faculty from the university’s Department of Bioethics, will discuss some of the complicated ethical issues they’ve had to confront related to COVID-19, including the allocation of medical care and resources in a crisis, in a roundtable discussion at noon tomorrow (Thursday, April 23).
One of the many ethical decisions that need to be made in a pandemic involves the criteria used to determine who receives care. To explore public opinion on that issue, Aulisio has been developing questions for a national poll to measure hypothetical indirect indicators of benefit, such as profession, age, disability status, life expectancy, marital status, number of dependents and others.
Other bioethics faculty are working to help the region prepare for related issues, such as the pandemic’s impact on people who need treatment for other health and mental health issues, but cannot access care at this time—and the effects that caring for COVID-19 patients can have on health professionals.
“What we’re seeing is increased stress from health care providers and the patients and their families,” said Monica Gerrek, assistant professor in the Department of Bioethics in the School of Medicine and co-director of both the Center for Biomedical Ethics and the Institute of Burn Ethics at the MetroHealth System. “Even if the patient isn’t diagnosed with COVID-19, there are concerns about visitation from loved ones, of having the appropriate PPE to stay safe while treating patients or even patients delaying doctor visits because they’re afraid to come in.”
Looking forward, both Gerrek and Aulisio are cautiously optimistic about the preparations that have been established to address a potential crisis situation.
“I think it’s good that we are addressing things head on, and that clinicians, ethicists, administrators and legal folks have had to work together to figure out how to best respond in the event that we have a dramatic surge in patients,” said Aulisio. “It’s going to happen at some point—whether it’s a second wave of COVID-19 or some new bug—and I know that we will be better able to respond as a region.”
In addition to Aulisio and Gerrek, Thursday’s panel also will feature faculty discussing additional questions relating to COVID-19, including disability rights, race, ethnicity and social determinants of health, ageism, and concerns about a return to normalcy. To learn more and receive a virtual link, please RSVP online.