Ethno-ethics Lens for Palliative Care Decision-making in COVID-19

Abstract

The Coronavirus Disease (COVID-19), which emerged in late 2019, has spread throughout the worldas a widely known pandemic, claiming over 3 million lives as of April 2021.1 The chaos resulting fromthe spread of this infectious disease caused great uncertainty and an urgent need to find an effectivetreatment. However, the issue in handling COVID-19 patients is limiting the number of patient careservices available. During the COVID-19 pandemic, palliative care has received significant publicattention.2 The COVID-19 patients with certain conditions who do not meet Intensive Care Unit criteriacan alternatively expect palliative care. Palliative care is handled by the Hospital Palliative Care Team,which offers decision-making support and psychosocial care for patients and their families.3Decision-making in palliative care has proven to be complicated because of the uncertainprognosis and general fears surrounding the decision. This indirectly creates ethical dilemmasfor patients, families, and health care workers. Spiritual and cultural aspects can influence thisdecision-making. By providing spiritual support and special care with consideration of thepatient’s values and beliefs during the illness, patients can make earlier decisions and have shownlower conflict decision-making and greater satisfaction with one’s decisions.4 Spiritual supportwould be beneficial and have a positive impact on ethical decision-making in inpatient care.According to the research of the history of global and multicultural societies in the 1980s,anthropological researchers have brought light to universalistic-nature ethical principles.5 In otherwords, these principles must be analyzed and acculturated with the local culture so that theycan accommodate potential local issues to produce derivative principles. This concept also takesinto account the four broad moral principles that existed to be the basis of modern biomedicalethics, entitled “Principlism”, which consists of respect for person (autonomy), non-maleficence,beneficence, and justice.6Palliative care, as a global issue, has been accommodated by the World Health Organization(WHO). In 2018, WHO released guidance on integrating palliative care and symptom reliefinto responses to humanitarian emergencies and crises. The elaboration shows that severalethical principles are relevant to be applied in the COVID-19 pandemic within the frameworkof “Principlism” to accommodate the issue of diversity in ethno-culture including:1. Respect for person (autonomy): All patients’ dignity and human rights must be respected,and health professionals should provide them with all health-related information, respect theirdecision-making, and provide appropriate recommendations;2. Non-maleficence: All patients should have access to palliative care to minimize sufferingand eradicate discrimination based on ethnicity, religion, gender, age, or political affiliation;3. Beneficence: The patients or family may have conflict with the public good such as infectiousdisease, so that the great judiciousness must be shown;4. Justice: Similar patients should be treated similarly regardless of ethnicity, religion, gender,age, or political affiliation.2In conclusion, in response to the COVID-19 pandemic, health workers are faced with thedecision to comply in accordance with the latest patient handling procedures. If health careworkers have made the best efforts, but the patient has experienced a poor prognosis, palliative careneeds to be the most potential alternative. The patient must be accommodated with an informedchoice so that patients with different cultural backgrounds can consider and make the bestdecisions for themselves and consciously accept the palliative care decisions that have been taken.Ethical principles in the framework of “Principlism” in a humanitarian crisis use an ethno-ethicslens to oversee potential ethical issues surrounding decision-making in palliative care. Healthcare workers must sensitively use these ethical guidelines to accommodate the ethno-culturebackgrounds of various patients. This global policy needs to be translated into each country’snational policies by elaborating the framework of “Principlism” to produce derivative rules thataccommodate local ethical issues in various dilemma situations with COVID-19 patients.

Keywords

• ethno-ethics
• palliative care
• decision-making
• covid-19