ICU Ethics Committee Meeting
ICU ethics committee meeting was assembled in the light of the spread of the recent pandemic of novel coronavirus (Covid-19). Its purpose was to create a set of guidelines for problematic ethical issues surrounding the ICU treatment of patients diagnosed with the disease. The committee was asked to outline the borders of practice, use of equipment, triaging methods, as well as the rights of nurses for self-determination in regards to the management and containment of the diseases. This paper will describe the function of those present at the meeting, their roles, observations, and interactions during the decision-making process as part of shared governance.
Roles and Functions of the Present Committee
The meeting was comprised of the hospital’s HEC (Hospital Ethics Committee) as well as several team-leading representatives from each group, members of which made up the ICU teams. Namely, the leading intensivist, pharmacist, respiratory therapist, and dietician were present, accompanied by two medical managers overseeing bedside nurses as well as clinician-in-training (Hajibabaee et al., 2016). The purpose of the assembly was to discuss several issues in regards to hospital and ICU management of the coronavirus crisis, with team leaders outlining possible ethical issues that may arise during work, and working in tandem with HEC to offer solutions with the best possible outcome.
Personal Observations
The meeting went smoothly, in a professional manner. It started with members of HEC introducing themselves and all those who attended. One member that was supposed to be present was missing. The medical manager overseeing the bedside nurses was the one to introduce the scope of the situation, stating the overall number of nurses and specialists working in the ICU unit and announcing the current and projected number of patients suspected of coronavirus. After that, each of the heads started voicing their concerns for equipment and understaffing issues. They discussed triaging equipment, medicine, and nursing staff.
Other concerns that were touched upon during the meeting of the committee were regarding nurse rights for protection against the disease. Bedside nurses were the ones most exposed to the risks of contracting the virus and potentially spreading it outside of the hospital. The ethical conditions for individual refusal to treat Covid-19 patients were being discussed. Finally, there was the issue of medical masks worn by all personnel, which were in short supply. The regulations regarding such masks during regular conditions suggested changing them every 3 hours (Park & Lee, 2019). The ethical complications of sterilizing and reusing vs. making homemade masks in an event of shortage were also talked about.
Decisions Made in Shared Governance
The discussion of the issues went on democratically, based on the principles of shared governance (Joseph & Bogue, 2016). The decisions were being agreed upon by the majority of the professionals, with members of the HEC team providing ethical guidance to the conversation. The important landmarks for guidelines were as follows:
- On triage of ventilator equipment. The decisions for triaging of life-supporting equipment will be made by independent arbiters rather than bedside clinicians, to avoid doctors advocating for their patients (Andersen, 2019);
- Due to shortages of nurses, a formal request would be made for nurses to stay on duty and consider additional hours. Such behavior would be incentivized. Refusal to do so, however, would be accepted without any questions;
- Nurses would not be allowed to refuse to treat patients with infections (Covid-19, others) if the hospital has provided all due diligence with minimizing the risk of infection(Park & Lee, 2019).
- The lack of protective equipment (masks) and the makeshift quality of replacements could be considered a reason for treatment refusal, by national and internal guidelines (Park & Lee, 2019).
- An investigation into the body of evidence to support (or deny) the re-use of available masks for patients and nurses alike would be conducted. Without evidence, it is impossible to make an ethical decision in regards to the proposed course of action (Park & Lee, 2019). Until then, re-use is prohibited.
Conclusions
The meeting was fruitful and provided a set of ethical solutions to problems that had an ethical and practical component to them. Members of the committee collaborated, providing their vision of the situation as well as recommendations. Pooling together thoughts and resources to achieve a positive outcome was done in accordance with the principles of shared governance. The decisions made in regards to ethical guidelines would be implemented in the internal recommendation sheet.
References
Andersen, B. M. (2019). Prevention and control of infections in hospitals. Springer.
Hajibabaee, F., Joolaee, S., Cheraghi, M. A., Salari, P., & Rodney, P. (2016). Hospital/clinical ethics committees notion: An overview. Journal of Medical Ethics and History of Medicine, 9, 1-9.
Joseph, M. L., & Bogue, R. J. (2016). A theory-based approach to nursing shared governance. Nursing Outlook, 64(4), 339-351.
Park, H. J., & Lee, O. C. (2019). Ethical awareness and decision-making of healthcare providers in response to pandemic influenza-focused on middle east respiratory symptom coronavirus. Korean Crisis Management, 15(1), 19-29.