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Work of a paediatric bioethics centre during the COVID-19 pandemic first phase
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  1. Joe Brierley,
  2. Sarah Aylett,
  3. Anne MacNiven,
  4. Mariana Dittborn
  1. Paediatric Bioethics Centre, Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Joe Brierley, Paediatric Bioethics Centre; National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital, London, UK; joe.brierley{at}gosh.nhs.uk

Abstract

Objectives Decisions with an ethical component have been controversial during the COVID-19 pandemic, whether leaked intensive care unit (ICU)-rationing documents, transfer of people to care-homes to ‘protect the National Health Service’ or the duty to treat patients despite inadequate personal protective equipment. To counter criticism of ethics per se, and to help those planning ethics support we describe the practical work of a children’s hospital bioethics team in supporting children, families and clinicians during this unprecedented period.

Design/setting Three phases of activity: (i) preparation: we composed several documents to support/guide hospital teams and, together with colleagues, provided them to regional inpatient, community and hospice settings. We adapted existing mechanisms to combat workforce moral injury; (ii) activity (March–June 2020): was highest in our rapid response service where children/families consider difficult treatment decisions with medical teams. Education provided ‘pandemic webcasts’ on decision-making and broader child-health concerns. Staff support was essential, especially for those deployed to overwhelmed local adult ICUs. Research ascertained young people’s views on the pandemic; (iii) reflection: focussed on (a) research about future re-deployment to adult services and minimisation of moral distress/injury, (b) remote video-conferencing—parents’/participants’ experience/ability to consider complex ethical issues and (c) role of faith/non-faith in society’s recovery and children’s views.

Main outcome/conclusions Our bioethics team’s role during the pandemic included: case reviews via video-conferencing, many involving innovative therapy for severely unwell children with COVID-19/Paediatric-Inflammatory-Multisystem Syndrome-Temporally associated with SARS-CoV-2 together with their parents; processes to protect healthcare staff from moral harm and research/educational activity focused on paediatric-specific ethical arising during the pandemic.

  • ethics
  • nursing
  • COVID-19

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Footnotes

  • Collaborators Linthicum James.

  • Contributors All authors worked together to redesign the bioethics team approach to COVID-19. JB led the team, wrote the major on documents and led education. SA led the rapid review service. AM did the staff support element. MD organised and facilitated all components. JB/MD composed the study and analysed the data and then wrote the paper with respective contributions from SA and AM of their areas. All authors contributed to the final documents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. No data available.

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