Posted: 4/18/2020

As I write this, we are likely in the midst of our COVID-19 peak in New Jersey. Most of the inpatients in my hospital are COVID-19 pneumonia patients with almost all available ventilators being deployed. Personal protective equipment (PPE) is very limited. The medical staff volunteers have been placed in COVID-19 teams which include a primary care doc, an infectious disease doc, and a pulmonary doc per floor. This preserves PPE and reduces risk to the physicians.

I would like to provide some insight on an area I have been working on outside of my usual Physician Advisor duties. I have participated in bioethics consults for 16 years, but a crisis such as COVID-19 brings new bioethics challenges to healthcare organizations. When placed in crisis mode with limited resources, difficult decisions and policies need adoption by leaders and the medical staff. In short, patients who are compromised to begin with who contract COVID-19 are unlikely to survive even if resources such as ventilators are deployed. When in a crisis mode, it becomes advisable to place such patients on a palliative clinical path and "save" the ventilator for another patient.

A team of two bioethics consultants and the palliative care physician have written a policy for our hospital. We are also monitoring similar policies authored at other facilities and policies posted on a state level. The state of New Jersey has also made efforts to protect health care providers, prohibiting future lawsuits related to decisions made in bioethical dilemmas. (Remember, New Jersey is the sue me state, not the Garden State.)

A significant number of long-term care patients and elderly patients with chronic diseases lack documentation of their medical wishes. This places medical staff in a difficult position. A pandemic causes this to be a more glaring issue. In my hospital, we have not gotten to the point where the pandemic is overwhelming the healthcare system to a point where we may have to enact a crisis mode of bioethics policy. We sincerely hope it does not come to that. But, preparation in this area is necessary and should be considered by all, regardless of what stage of the curve your area is in.

Howard Stein, D.O.
Associate Director of Medical Affairs, Senior Physician Advisor Care Management
Centrastate Medical Center, Freehold NJ