Best Practice in Clinical Ethics and Compassionate Care during COVID-19 Crisis: CHAPTER 1 - CRISIS DECISION-MAKING SUPPORT PATHWAYS

INTRODUCTION

• Clinical ethics is analytic and reflective. It gives clarity and suggests resolution.
• There is a difference between a patient-centred approach to clinical care on a normal day and a public-centred approach to clinical care during the pandemic crisis. Thus, clinicians face what we call moral distress (MD) during the pandemic, which results from a perceived violation of one’s core values and duties, concurrent with a feeling of being constrained from taking the ethical or right actions. 
• MD could originate from a different clinical decision-making flow and standard of care, an altered patient and physician relationship, the limited chance for the usual personal and compassionate care, and the constant conflict of obligations between patients, self, colleagues, and families. 

OBJECTIVES

• These chapters aim to guide and support clinicians, and eventually reduce the impact of public health-centred clinical care on clinicians, patients, and families. Along with practical steps and tools, they give clarity and suggests ways to resolve some of the most challenging clinical practice during the COVID-19 pandemic.

"Best Practice in Clinical Ethics and Compassionate Care during COVID-19 Crisis"

CHAPTER 1: CRISIS DECISION-MAKING SUPPORT PATHWAY - A CONCEPTUAL FRAMEWORK FOR MALAYSIAN HOSPITALS

• Crisis decision-making for limited resources could be systematic. It’s important to understand the true purpose in the provision of patient care. On one hand, there is a duty to care and plan during a crisis, on the other, it's unethical to provide care that will not benefit or causes more pain and harm to the patients, or undermining public health interests. 
• We propose a conceptual framework for Malaysian hospitals in which patients are put at the right place for the right care, especially when managing limited resources such as intensive care. It's critical to be clear about the right clinical assessment tools, level of decision-making (who makes those decisions), and resolution pathway (how do we resolve disagreement of complex cases). 
• The whole process of deciding for beds or intensive care should not be just a sole clinician decision. The clinical and moral burden needs to be shared and be part of a more extensive system response at the hospital and the regional level, which includes bed management strategies, patient and family communication, psychosocial care plans, and also acceptable exit plans when patients do not respond or further deteriorate. This flow encourages good oversight with a hospital-level crisis advisory board and other risk management procedures.

Related chapters:

Chapter 2 - DNR And End-Of-Life Care - Decision, Communication, And Management. http://doi.org/10.5281/zenodo.5111544 
Chapter 3 - Palliative Care. http://doi.org/10.5281/zenodo.5101092 
Chapter 4 - Compassionate Care. http://doi.org/10.5281/zenodo.5105289 

Contact email: ethicsampang@gmail.com (HESS)

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