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Putting Patients First during COVID 19 – our ethical decision making process

The COVID 19 outbreak has been the biggest challenge our NHS has ever faced. Its impact on patients, families and healthcare workers is unprecedented and is likely to last for many months, if not years to come.

The conversations which normally take place between clinical teams, patients and their carers about options for, and decisions on, treatment are made much more challenging by the nature of the virus, its impact on patients and the wide-ranging restrictions on visiting that are necessary to protect patients, the public and staff.

This makes it more important than ever that decisions about treatment options for patients, which may need to be made quickly and in difficult circumstances, are also made in ways which are as inclusive, transparent, reasonable and responsive as possible.

To support clinical teams often working in highly pressured environments with this decision-making process, we have developed a policy for making ethically balanced decisions during the COVID 19 pandemic. This policy aligns with the ethical framework for Herefordshire and Worcestershire Integrated Care Network.

It provides a decision support tool to promote consistency and clarity and also sets out an escalation process which balances the need for timely decisions with the safeguard of additional scrutiny of the most sensitive decisions.

It is designed to complement existing policies such as ReSPECT, to allow patients maximum influence over decisions regarding their care options (including those where a patient expresses a view about where they wish to be on the spectrum/line between prioritising sustaining life at all cost or focussing on symptom control with no attempt to sustain life).

Use of the decision support tool will identify if any aspect of a patient’s care raises ethical issues

If these issues are raised, they can be referred to one of two ethics groups for consideration.

All cases will be reviewed in a virtual panel meeting.

The meeting for simpler issues will be chaired by a designated consultant with the rest of the panel consisting of other clinicians, a senior nurse and a GP with support from a member of the chaplaincy service.

That for complex cases will also include input from the Trust’s Chief Medical Officer, Chief Nursing Officer and a Divisional Director

All decisions will be documented, reported to the Hereford and Worcestershire COVID 19 Ethical Committee and shared with the Sustainability and Transformation Partnership.

Audit/monitoring: Compliance with the policy will be measured by a variety of means including spot audits.

The full policy can be read here.

Frequently asked questions to accompany COVID Ethical Policy - June 2020

Will my disability affect the care I receive?

Disability is not a factor in decision making in the tool.  Only those things which influence the response to treatment are included

Does the policy allow for things like Power of attorney and Living Wills?

Power of Attorney and living wills will enable the team to be informed about the wishes of individuals.  The use of ReSPECT forms is to be encouraged for all who wish to determine the level of medical intervention they wish to accept. 

If I have Power of Attorney for my relative, does this give me any say in their treatment?

The process will take in to consideration the views of family members.

How will my wishes as expressed in my RESPECT form be followed?

The use of the ReSPECT form will be critical part of the pathway and will inform the decision making in every case where one is available.

How will my age affect the treatment I get?

Age is an important determinant in the likely response to some treatments and will be one of the factors which will be used to help make a decision on the optimal care pathway for individuals.