Coping With Moral Distress and the Bioethical Burden of the Pandemic. Sponsored by ACLP's Bioethics SIG

Abstract: In March 2020, hospitals across the country prepared to face the COVID-19 pandemic that completely shifted how medicine is practiced. The great sacrifices providers made at the start of the pandemic were thought to be invaluable acts that could mitigate the pandemic. Now in the third year of the pandemic, providers face new, increasingly virulent strains of the coronavirus, and many are exhausted. The level of altruism deemed necessary at the start of the pandemic has proven unsustainable, yet in many settings, this near total commitment continues as there appear to be no safe options for patients.



In this workshop, speakers will lead attendees in identifying and processing pandemic related bioethical dilemmas and the moral injuries that resulted when these could not be adequately resolved. Each speaker will focus on common problems CL psychiatrists continue to confront while exploring potential solutions. Participants will be organized into small groups to discuss difficult cases and challenged to propose strategies to overcome these difficulties.



Dr. Adsule will moderate the workshop.



Dr. Geppert will first introduce the concept of moral injury, explain how it differs conceptually from moral distress and emphasize the ethical dimensions of how healthcare professionals have experienced moral injury during the COVID-19 pandemic.



Dr. Mazur will lead a discussion on the role of vaccine mandates and how these compounded providers’ moral injury. Vulnerable patients who refuse to be vaccinated and are then denied treatment or access to resources, such as in transplant candidacy or placement in certain care facilities, cause great emotional strain on healthcare workers. Additionally, disagreement among healthcare employees about the mandate can create significant moral distress among team members expressed in discord the CL psychiatrist must try to resolve.



Dr. Zwiebel will lead a session covering the ethical concerns and related moral distress and injury that occur when psychiatric patients who are incidentally COVID-19 positive cannot be placed in a psychiatric unit, and are instead admitted to an urgently needed medical bed. This scenario leaves the medical team, CLP team, and nurses providing primary psychiatric care in an environment that completely isolates the patient. Alternatively, psychiatric units for COVID-positive patients leave patients and staff in a constant state of exposure. The undomiciled, asymptomatic COVID-positive patient with nowhere to go causes further distress.



Dr. Erickson will guide participants through cases of patients who decline evidence-based treatment or request non-evidence based treatment for COVID-19t. In the digital age of rapid information exchange, many patients look to political, entertainment, and social media stars to inform their medical decision-making. Idiosyncratic views rapidly become mainstream, and the CL psychiatrist must adapt assessment standards in a culture of alternative medicine and misinformation to redefine the boundaries of promoting beneficence and non-maleficence.