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Clinical Ethics Consultation in the Covid-19 Pandemic. Practical Challenges for Safety and Quality

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Pandemics and Ethics

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Abstract

The Corona pandemic poses a great challenge for medical and ethical counseling. Several areas of institutionalized expertise need to be distinguished here: At the level of care in hospitals, clinical ethics committees are required to deal with the problems and issues arising in the context of Covid treatment measures. The present article is dedicated to the practice of clinical ethics counseling and, based on cases that have arisen, sheds light on requirements in everyday life. Different forms of (in-)security in clinical practice in relation to the conduct of ethics counseling by telephone (2.) and video conference (3.) are considered, problems of relevant safety measures (4.) as well as “clinical side effects” of the pandemic (5.) are mentioned. In addition, the striving for quality assurance for clinical trials and research (6.) as well as the moral questions of the distribution of ventilation places and triage at the sickbed (7.) are to be discussed. Finally, summary considerations on security and insecurity under the conditions of the Covid-19 crisis and possible perspectives and necessary structural developments for the future (8.) are to be presented.

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Notes

  1. 1.

    For the German-speaking area, it must be seen that the terminology in Switzerland uses the terms ethics commissions and ethics committees reversed. The example of the Federal Republic of Germany is used below. Of course, there are also other institutions in addition to the three mentioned bodies, such as the Central Ethics Commission at the German Medical Association (ZEKO) and others.

  2. 2.

    This article is a revised and expanded version of the article Frewer (2020). I would like to thank both publishers for their permission to use modified and updated sections of the article from the “Jahrbuch Ethik in der Klinik” (Königshausen & Neumann).

  3. 3.

    For ethics consultation specifically at the University Hospital Erlangen, see, for example, Kaschube et al. (2019), Krull et al. (2019) and Frewer (2019) as well as for theory in particular Frewer and Hack (2019). For basics Frewer et al. (2012) and in general the Jahrbuch series (JEK).

  4. 4.

    The University Hospital Erlangen is a house of maximum care with around 1,500 beds and 7,000 employees. The Clinical Ethics Committee was initiated at the beginning of 2000 and is thus one of the first committees in university medicine. The Chair of Ethics in Medicine at the University of Erlangen-Nuremberg runs the office of the Ethics Committee and several working groups (Frewer 2019).

  5. 5.

    On the palliative care unit, at that time two visitors could be selected and specified for dying patients within the framework of the Corona conditions.

  6. 6.

    Here, the guideline paper developed by DIVI, AEM and other professional societies as well as private individuals should be mentioned in particular (DIVI et al. 2020). The author of this article was involved in this process. A multi-layered discussion is taking place, for example with regard to the rights of people with disabilities. See also Marckmann’s contribution in this volume.

  7. 7.

    The differences between “subjective” and “objective” perceptions of security cannot be discussed in depth here, even though these things are not only individually, but also structurally of great importance, for example in terms of strategies for securing in the sense of defensive medicine (with follow-up problems of overdiagnosis to futility, etc.).

  8. 8.

    The personal level of planning security cannot be discussed here, but it should only be mentioned that even in the team of the office of the Ethics Committee, greater uncertainties have arisen in some Covid phases, for example through the possible upcoming division for pandemic deployment in intensive care medicine or also necessary quarantine phases abroad, etc.—pandemics are prime examples of the development of uncertainties at all levels.

  9. 9.

    The head of the KEK office and author of the present article was initially involved here as well as in individual forums of the AEM. In addition, he was one of the experts in the short-term assessment of the AEM-DIVI guideline, see DIVI et al. (2020) as well as in prioritization in the regional vaccination center.

  10. 10.

    In the present case there were contacts to another large hospital in the city with an exchange of experiences at the level of chairpersons and office managers. At this stage, a newspaper article in the local press “Serious allegations …” had been raised and the daughter of a deceased Covid-19 patient suspected negligence in clinical care (Erlanger Nachrichten from May 5, 2020); this was discussed in a working group.

  11. 11.

    Here, critical exchange in public discourse is very important. In addition to publications in the journal Ethik in der Klinik, the Clinical Ethics Committee and the AG Ethikberatung have also stimulated further publications, see, for example, Jäger and Gründel (2020) with explicit thanks to the Ethics Committee.

  12. 12.

    See also German Ethics Council (DER) (2020), Fischkoff et al. (2020), Knox (2017), National Academy of Sciences Leopoldina (2020), Reis (2016), Swiss Academy of Medical Sciences (SAMW) (2020), The Hastings Center (2020) and Working Group Ethics/AG Ethik (2020).

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Acknowledgements

I would like to thank the staff of the office of the Clinical Ethics Committee (CEC) as well as the committed members of the Working Group Ethics Consultation of the CEC at the University Hospital Erlangen (UKER) for their support.

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Authors and Affiliations

  1. Professorship for Ethics in Medicine, Erlangen-Nürnberg University, Erlangen, Germany

    Andreas Frewer

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  1. Andreas Frewer
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Correspondence to Andreas Frewer .

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  1. Health Ethics and Governance Unit Department of Research for Health, World Health Organization, Genf, Switzerland

    Andreas Reis

  2. Professur für Health Care Ethics, Karl-Franzens-Universität Graz, Graz, Austria

    Martina Schmidhuber

  3. Professur für Ethik in der Medizin, Universität Erlangen-Nürnberg, Erlangen, Germany

    Andreas Frewer

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Frewer, A. (2023). Clinical Ethics Consultation in the Covid-19 Pandemic. Practical Challenges for Safety and Quality. In: Reis, A., Schmidhuber, M., Frewer, A. (eds) Pandemics and Ethics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-66872-6_18

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