Note: This thread is related to #Coronavirus #COVID19

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Colleen Farrell, MD+ Your Authors @colleenmfarrell Internal medicine resident in New York City. Soon-to-be pulmonary and critical care fellow. Writer. Creator of @MedHumChat. Views mine. May. 22, 2020 2 min read + Your Authors

The Fellowship at Auschwitz for the Study of Professional Ethics was one of the most transformative experiences of my education. I was honored to join @FASPEnews for a webinar on medical ethics during the covid pandemic. You can watch it here:  https://www.faspe-ethics.org/webinars/  #bioethics

I'll share here a few points I shared in the @FASPEnews webinar re #bioethics from my experience caring for patients with covid, primarily in the ICU... 1/

The news tends to focus on macro issues of ethics (appropriately): how do we ration ventilators; what duty do HCWs have to their patients; how should experts communicate with the public. Each issue has a micro correlate at the bedside. 2/

First I will add that I hesitate with normative bioethics (oughts, shoulds, etc). It's often more important to *identify* an ethical dilemma rather than answer it. A lot of ethical failures come from not identifying an ethical dilemma in the first place. 3/

🔹micro ethics: rationing

I don't make policy on vent rationing. But, as a HCW I myself am a finite resource of time and energy. Which patients do I focus on? How might implicit biases shape the allocation of my bedside time? 4/

🔹micro ethics: duty

I've accepted I will face some risk caring for patients with covid. But how much risk? What is my threshold for visiting the bedside? Only acute medical issues, or to comfort, or discuss goals of care? 5/

🔹micro ethics: truth-telling

I construct a narrative of the hospitalization for patients families that they can't be there themselves to witness. How do I balance hope vs realism? How much do I share of resource limitations or things I wish we could do better? 6/

One of my mentors, Dr. Ed Hundert, told me that just like ever case is a physiology case, every case is an ethics case. The hard part is being attuned to ethics in our daily work. The ethical challenges during covid have only expanded. 7/

Formal bioethics can be dense & intimidating. An ethical dilemma is simply when moral goods are in conflict with another. truth telling vs hope; caring for one patient vs another; protecting oneself vs a patient. there's often no single right answer, but there are wrong ones. 8/

Sometimes we know the morally correct answer but there are tremendous pressures to do the wrong thing. It takes *moral courage* to do the right thing. I am so grateful for my experience with @FASPEnews for teaching me history in a way that cultivates this moral courage. 9/

I took this picture at Auschwitz, on my @FASPEnews fellowship. I wanted it to serve as life-long reminder to me that when the trains arrived at Auschwitz, it was a physician who decided who went to the gas chamber directly and who worked till death. A physician. 10/

The moral stakes of our work are great, especially in such times of crisis. We need to keep our eyes open to moral questions, cultivate moral courage, and elevate examples of ethical leadership. 11/11


You can follow @colleenmfarrell.



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