Work of a paediatric bioethics centre during the COVID-19 pandemic first phase

Area of Science:

• Medical Ethics
• Pediatric Bioethics
• Public Health Crises

Background:

• The COVID-19 pandemic presented unprecedented ethical dilemmas in healthcare, including resource allocation, patient care duties, and staff well-being.
• Ethical controversies arose concerning intensive care unit (ICU) rationing, patient transfers, and the provision of care with inadequate personal protective equipment (PPE).
• Children's hospitals faced unique ethical challenges in supporting pediatric patients, families, and healthcare professionals during the crisis.

Purpose of the Study:

• To describe the practical functions and support provided by a pediatric hospital bioethics team during the COVID-19 pandemic.
• To offer insights for planning ethics support services in similar healthcare settings facing public health emergencies.
• To address criticisms of ethics support and highlight its crucial role in navigating complex medical and ethical decisions.

Main Methods:

• The study outlines a three-phase approach: preparation, activity, and reflection.
• Preparation involved creating guidance documents for hospital teams and adapting mechanisms to address workforce moral injury.
• Activity included rapid response case reviews (often via video-conferencing), educational webcasts, staff support (especially for those in adult ICUs), and research on youth perspectives.
• Reflection focused on research regarding redeployment, minimizing moral distress, evaluating remote conferencing for ethical discussions, and the societal role of faith.

Main Results:

• The bioethics team conducted case reviews for severely ill children with COVID-19 and Pediatric Inflammatory Multisystem Syndrome (PIMS-TS), involving innovative therapies and parental consultations.
• Processes were implemented to protect healthcare staff from moral harm, addressing moral injury and distress.
• Educational and research activities focused on pediatric-specific ethical issues that emerged during the pandemic.

Conclusions:

• The pediatric bioethics team played a vital role in navigating complex ethical decisions during the COVID-19 pandemic.
• The team's multifaceted approach, including case reviews, staff support, and research, was essential for children, families, and clinicians.
• The experience highlighted the need for robust ethics support systems in pediatric healthcare, particularly during public health crises.