The Truth of COVID-19: An Ethicist Reflects on His Experience

I have been honored and privileged to serve the Kansas City region through my work at the Center for Practical Bioethics during this challenging year of COVID-19. My role has grown during this pandemic, as I share in the work of providing ethics services in several hospital systems in the region. This has involved front-end work, including structure and policy development, as well as groundwork such as conducting clinical ethics consults and supporting medical staff with ethics education and guidance. I am grateful to help our hospitals and health systems prepare for, manage and move forward in facing the ethical challenges of the pandemic. 

But this role comes with an additional emotional burden. While I share in these organizations’ successes as they build and grow ethics services, I also share in their hardships and challenges as we work to address highly unusual and sometimes unprecedented ethical issues. This access and knowledge have led me to a foundational truth about the COVID-19 pandemic: People are our greatest resource, and they are not an unlimited one. 

Every one of the healthcare workers I’ve encountered is exceptional, and exceptional people step up and grow during the most challenging times. That is exactly what I have seen this year. As a society, we place high expectations on healthcare workers. We take advantage of their skills and rely on their dedication. When patients arrive at the ER, we expect fast response and quality service. When patients receive a cancer diagnosis, we expect the marvels of medicine and intimacies of compassion. When a family member is in the ICU, we expect the best care possible. These expectations exist because that is what healthcare workers deliver, day after day after day. And when a global pandemic uproots our lives and threatens the health and safety of everyone, new expectations are placed upon healthcare workers. And again, they rise to the challenge. 

A Finite Resource

But this resource is not infinite. Why? 

• Hospitalizations Rising –  Not every hospital is at maximum capacity or needs to implement crisis standards of care. But after months of challenges and difficulties for our healthcare workers, we are entering a new time with more expectations. In the beginning of the pandemic, we faced the crisis related to shortages of PPE (personal protective equipment). Now we must face the possibility of a shortage of those who wear the PPE. As hospitals reach new levels of capacity and with new COVID-19 units being established, staffing is stretched to extremes. There are potentially not enough qualified clinical staff to care for the levels of patients in need of care. This is only expected to worsen as infections spread.

• Moral Distress – Distress from being required to do things that conflict with one’s conscience, professional duty and moral principles is particularly stressful now for front-line healthcare workers. These are individuals who are making the decision to go to work, day-in and day-out during this crisis, risking their health and safety and the health and safety of their families because they believe in the importance of their work. Selflessness does not begin to describe that level of commitment to their fellow companions. They see first-hand the burdens, the true pain and suffering, that the pandemic brings. 

The Empty Glass

I have worked intimately with many of these front-line healthcare workers and have heard their stories. Stories that bring the truth of COVID-19 to anyone willing to listen. 

• I have heard from the physician who stayed on for an additional shift to honor his promise to a dying patient whose family was unable to visit that he would not die alone. 

• I have heard from a nurse who was unable to see immediate family because of fear of bringing the virus back home.

• I have heard from a physician who watched four patients suffer and die from COVID-19, only to return to the clinic and be told by another patient that it was all political and that the virus would be gone after election day. 

Healthcare workers pour themselves into their work and their patients, like water from a glass. Without help, support and consideration, the glass eventually empties, and they have nothing more to give. This is what comes with the job and is a load shared by all. It is a why healthcare workers earn the respect we give them. 

United We Stand

Supporting our healthcare workers must be a united fight, or it is destined to fail. When faced with nearly impossible odds, Sir Winston Churchill said he had “nothing to offer but blood, toil, tears, and sweat.” His nation stepped forward to fight the threat to life and safety; from the solider to the factory worker to the caregivers at home and leaders at the top, they all gave everything together and overcame the grave threat. 

I have seen our great healthcare workers give all this and more to fight this fight against COVID-19, but I see some in leadership outside of the hospital step away, deny or ignore the threat and the fight. This is destructive to so much that we hold dear. This is a fight that will possibly worsen before it improves. We see the impact it has right now and fear what the future might hold.

I have had the privilege to work and share with those fighting and giving everything. 

We must not let them fight alone.

Ryan Pferdehirt, D. Bioethics, HEC-C

Clinical Ethicist

Director of Membership and Ethics Education