Navigating the ethical challenges of COVID-19
The caller on the line was distraught. His wife was undergoing cancer treatment at the Jewish General Hospital and desperately needed his support, but COVID-19 directives prevented him from being by her side.
“He was sobbing,” recalls Kevin Hayes, our CIUSSS’s Clinical Ethicist. “He wanted so much to be there to comfort her. I felt like he wanted to drive a tank through our doors—that’s how determined he was to get himself inside.”
The situation presented the kind of ethical dilemma that makes its way regularly to Mr. Hayes and the Clinical Ethics Service of CIUSSS West-Central Montreal. On the one hand, a spouse seeking to fulfill his duty to support his partner in a time of need. On the other, a healthcare system struggling to survive the threat of a global pandemic.
Ethics often involve opposing values and a difficult choice. This was one of them.
“This man felt he had to be there for his wife, and from a human point of view it was completely understandable,” says Mr. Hayes. Yet the CIUSSS was required to apply government COVID-19 directives. Safeguarding healthcare services was crucial.
“If your patients and healthcare workers become ill, your situation becomes catastrophic,” he says. “So if we let everyone in and it’s too late later on, what are you going to do?”
In the end, steps were taken to allow the man to see his wife when she was transferred to Palliative Care. Adhering to government rules, he donned full protective equipment and was able to say a final goodbye.
The couple’s story crystallizes the sorts of quandaries created by COVID-19. Before the pandemic, Mr. Hayes spent years weighing moral conundrums that inevitably arise in a large healthcare network such as ours: disagreements over care, the withdrawal of active treatment, or choosing to live at risk in the community, to name a few. Trained with a Master’s degree in Bioethics from McGill University, Mr. Hayes fields queries from employees, users and family members, and has given more than 150 training sessions to staff on our CIUSSS’s Ethics Framework.
“That’s the mandate of healthcare professionals. They got into this profession to help people, not to judge people.”
But there were few precedents for the kinds of stark choices forced upon decision-makers by COVID-19.
“The entire world had to make drastic decisions to ensure the greater good,” he says.
At times, Mr. Hayes was called upon to act as a mediator. In one case, an elderly woman was ready to be discharged from the JGH; her physician and social worker said her needs and safety would be best served in a long-term care centre.
The woman’s children resisted. They had read about the turmoil in long-term care homes at the start of the pandemic, and preferred that their mother stay away.
“They were not doing this to be difficult. They were really worried,” he says.
Mr. Hayes, whose office is part of the Quality, Innovation, Evaluation, Performance and Ethics Directorate, told them about all the measures that had been put into place to ensure the safety of staff and residents in long-term care, and how it was in their mother’s best interests to be placed there.
“I explained why it was the right thing to do, even if they were afraid to do it,” Mr. Hayes says. The woman went, supported by her CIUSSS healthcare team.
COVID-19 has forced other ethical questions to the surface—such as why healthcare staff must treat patients who refuse to be vaccinated. “There’s lot of judgment out there during COVID-19 about who’s good and who’s bad, because they didn’t do this or didn’t do that,” he says. “But our duty to care is crucial. That’s the mandate of healthcare professionals. They got into this profession to help people, not to judge people.”
“Even if I don’t have all the answers, I’m there to listen.”
Mr. Hayes, who is based at the JGH but serves all the facilities of our CIUSSS, worked on-site throughout most of the pandemic, donning scrubs or protective gear to do his job. All around him, he saw staff and managers pushed to the brink to keep the system running and to maintain safe, quality care. “They gave of themselves and sacrificed their own personal lives to commit themselves to patients and families. The humanity of these healthcare professionals was amazing.”
But what remains with him the most is the anguish of the husband who couldn’t see his wife. Prior to COVID-19, he had accompanied her to every blood test, scan and doctor’s appointment; suddenly, he couldn’t be with her. “It really made me see the pain of COVID-19,” Mr. Hayes says.
More than a year later, the man still calls Mr. Hayes, expressing his gratitude for the empathy he felt during his ordeal. “It makes me feel like I made a difference,” Mr. Hayes says. “Even if I don’t have all the answers, I’m there to listen.”
Do you have an ethical question you’d like answered? Do you want training on our CIUSSS’s Ethics Framework? The Clinical Ethics Service offers consultations and education for patients, residents, and their families or for substitute decision-makers. Contact Kevin Hayes at kevin.hayes.ccomtl@ssss.gouv.qc.ca or at 514-340-8222, extension 23625.
