BY LISA EISENHAUER
May 6, 2020
When it comes to responding to a crisis such as the current pandemic, Dr. Allen Roberts suggests that health organizations follow the example of Chesley Sullenberger III, the pilot who calmly landed a commercial airliner in the Hudson River off Manhattan in January 2009 after a birdstrike disabled both engines. Sullenberger's heroics were depicted in a motion picture whose title is the same as his now-famous nickname, Sully.
Roberts
"Organizational ethics, I believe, are encapsulated in the person of Sully Sullenberger in this movie, where he went from a business-as-usual model to a contingency to a crisis model on very short order, and delivered safely both his staff and, if you will, his patients, the passengers on the airplane," Roberts said. He noted that of the 155 people onboard the ill-fated US Airways plane, a "very few people had very minor injuries." There were no fatalities in the incident, which became known as "the miracle on the Hudson."
Roberts shared his enthusiasm for Sully, the pilot and the movie, during a webinar on organizational ethics April 30 that was the third of a series titled "Catholic Ethics and the challenge of COVID-19." The series is being presented on consecutive Thursdays through May by CHA and Georgetown University with participation from the Pellegrino Center for Clinical Bioethics.
Roberts, a professor of clinical medicine and associate medical director and chair of the ethics committee at MedStar Georgetown University Hospital in Washington, D.C., was joined in the discussion by Sarah Vittone, a clinical bioethicist for the Pellegrino Center for Clinical Bioethics at Georgetown University and an assistant professor at Georgetown School of Nursing. She works in clinical nursing administration at Suburban Hospital — Johns Hopkins Medicine in Bethesda, Maryland.
Building a framework
The two discussed how Catholic health systems should base their care and planning on ethical principles that never waver.
Vittone
Vittone defined organizational ethics as "the application of an ethical framework to a system of care, including its structure, policies and practices." For Catholic health care organizations, she said the ethical framework should be inspired by Christian values and include respecting human dignity, providing holistic care, promoting justice in the workplace, looking out for the poor, contributing to the common good and being sound financial stewards.
Vittone said it is important for Catholic care providers to remember that even amid the current global health emergency caused by the COVID-19 pandemic, ethics should guide all decisions and actions. The need to follow those foundational principals, she said "is required more, not less, in dire circumstances, and provides the necessary framework in these novel circumstances."
Roberts noted some of the unique aspects of the virus that had taken more than 60,000 lives in the United States alone by the end of April. It is highly contagious, it manifests in extremely different ways from causing no symptoms to causing respiratory and then multi-system failure and it has an especially high mortality rate for older patients.
Health systems have had to move to contingency plans to address the pandemic when some vital resources such as ventilators became scarce in COVID-19 hotspots, Roberts said. The challenge for hospitals and health systems, he said, has been to figure out how to avoid, for as long as possible, the crisis stage in which operating conditions are extreme, capacity is exceeded, and care quality is diminished and may be substandard. This requires creativity, such as making use of veterinary ventilators during a ventilator shortage and training hospitalists to work as intensive care doctors.
Crisis with a wide scope
Roberts and Vittone pointed out that the scope of the current emergency and the fact that pandemic patient surges can stretch for months also create special considerations for hospitals and health systems. Those include meeting the needs of the families who are struggling with long separations from critically ill patients due to visitation restrictions, treating each patient as an individual, being sensitive to those who are more vulnerable to having complications from the virus and figuring out how to care for non-COVID patients whose needs have gone unaddressed amid the pandemic.
In addition, they said, health system leaders must remember that they have an ethical responsibility to protect their own workers. "These are the people who are out on a limb for us, and we have to make sure that these people, who are ready to take up the challenge, are the ones that we are protecting," Vittone said.
Returning to his Sully analogy, Roberts said just as the skilled and seasoned pilot relied on his knowledge of the physics of the plane and his good sense when executing an emergency water landing, health systems should rely on medical knowledge and sound ethical practices when steering through a crisis.
Labor and delivery concerns
In the second part of the webinar, Dr. Siva Subramanian discussed ethical issues for women with COVID-19 who go into labor, and care of their newborns. Subramanian teaches pediatrics, neonatology, and offers instruction on religious traditions and health care and complementary and alternative medicine at Georgetown University Medical Center. He is chief of the neonatal intensive care unit.
Subramanian
He said that while COVID-19 is new and research on it preliminary, early findings suggest that the virus is less severe for the young than the elderly. While that is a positive development, he pointed out that it also potentially presents a risk in that children can appear to be asymptomatic and still be carriers.
Subramanian said research also suggests that the virus does not pose a worse risk for pregnant woman than for other adults. There is also no proof that the virus poses special risks for fetuses or the newborns of women infected by the virus.
Based on available research, Subramanian said he disagrees with the recommendation of the American Academy of Pediatrics that mothers who have the virus should be separated from their infants. He said he and his Georgetown colleagues support the guidance of the World Health Organization and other health groups that mother and child should stay together and have skin-to-skin contact with that caveat that infected mothers wear masks and wash their hands before and after touching their babies.
"We from Georgetown have written to the experts in AAP and hopefully the recommendation to separate will change," he said.
The next webinar in the series will be 30 minutes and start at 1 p.m. Eastern Time on Thursday. The topic will be "Moral Distress on Caregivers and Patients Dying Alone."
» The bottom line for Catholic ethicists in a pandemic: Stay in contingency mode
» View the webinar
» Download the Powerpoint PDF
Prior coverage of this webinar series
» Resuscitation considerations go beyond patients amid pandemic, Catholic ethicists say
» Putting health workers first for some treatments amid pandemic is justifiable, ethicists say