COVID-19-related ethics consultations at a cancer center in New York City: A content review of ethics consultations during the early stages of the pandemic Review


Authors: Novetsky Friedman, D.; Blackler, L.; Alici, Y.; Scharf, A. E.; Chin, M.; Chawla, S.; James, M. C.; Voigt, L. P.
Review Title: COVID-19-related ethics consultations at a cancer center in New York City: A content review of ethics consultations during the early stages of the pandemic
Abstract: PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient's concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n=3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages. (c) 2020 by American Society of Clinical Oncology
Keywords: clinical ethics
Journal Title: JCO Oncology Practice
Volume: 17
Issue: 3
ISSN: 2688-1527
Publisher: American Society of Clinical Oncology  
Date Published: 2021-03-01
Start Page: e369
End Page: e376
Language: English
ACCESSION: WOS:000655506700008
DOI: 10.1200/op.20.00440
PROVIDER: wos
PMCID: PMC8258018
PUBMED: 32853121
Notes: Review -- Source: Wos
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MSK Authors
  1. Sanjay Chawla
    22 Chawla
  2. Yesne Alici
    67 Alici
  3. Louis Pierre-Paul Voigt
    62 Voigt
  4. Monique C James
    4 James
  5. Amy Engel Scharf
    4 Scharf
  6. Martin S. Chin
    2 Chin