COVID-19: Clinical Ethical Issues During and After Pandemia. Stakeholders perspectives. – ETIC-COVID

The COVID-19 pandemic is deeply destabilizing countries and their organizations, particularly in the healthcare field. Likewise, the usual ethical standards in the medical field are being disrupted. Such disruption causes anxiety or disarray among healthcare professionals, patients and their families. The ethical reasoning in  clinical decisions is challenged. Therefore, the French National Ethics Advisory Committee (CCNE) has recommended the establishment of "ethical support cells". Since 2002, the Clinical Ethics Centre (CEC) in Paris has been operating as a mobile team to assist stakeholders in case of ethically difficult medical decisions. It thus appears crucial to propose a project that could help healthcare teams and patients or proxies to deal with the current health crisis or at least to express their ethical dilemmas and reflections during this time.
The study will consist of two phases. The first one will take place during the health crisis. This part of the study will be prospective. It will consist of phone interviews, mainly with healthcare professionals, focusing on their ethical dilemmas. Debriefing meetings with the healtcare teams will follow at the end of the emergency. In the second phase, the study will be retrospective. It will consists of face-to-face interviews with : 1) Healthcare professionals (physicians, nurses, psychologists) in different healthcare services (ICU, emergency wards, geriatrics services, nursing homes, infectious diseases units, COVID+ unit) 2) patients who have survived COVID+ and 3) relatives of patients, who may or may not have survived COVID+.
Through the two phases of the project, the researchers will attempt to understand how the ethical reasoning of those primarily concerned by COVID-19 changes with respect to three main dimensions: 1) the dimension of medical decision making (clinical ethics): how does the balance between the principles of biomedical ethics (respect for autonomy, beneficence, non-maleficence, justice) change in clinical decision making ? 2) the institutional dimension (institutional ethics): how do health organizations  influence the care of patients and their relatives and clinical decisions during the crisis? 3) the dimension of support care (relational ethics): how is information exchanged between healthcare professionals, patients/proxies and society? Is transparency a guarantee of trust ? What about the care of the dying and their relatives?
Researchers will seek to identify whether ethical issues and clinical practices have changed as a result of this health crisis, particularly in the context of end-of-life care.
The methodology here proposed has been developed by the CEC over the last 15 years, and it relies on : 1) a central focus on the discourse of stakeholders, including patients/proxies, 2) an ethical appraisal of situations and 3) a strong multidisciplinary approach which involves both medical and non-medical researchers (nurses, researchers in humanities, citizens), 4) a qualitative analysis of the interviews, 5) a contribution to the public debate.
The CEC could help to better understand the ethical issues related to the COVID-19 epidemic as perceived by stakeholders, in order to face new challenges and to further reflection on these societal issues.