End-of-Life Complications During the COVID-19 Pandemic

Dying alone is a fear many face at the end-of-life. Closure from family can help combat the loss of control many feel as they go through the dying process, and traditionally, hospital visits from loved ones have been encouraged at the end-of-life.

However, the COVID-19 era has brought about many changes in hospital policies and procedures. Drastic steps have been taken to slow the spread of the virus, including limiting or banning hospital visitors in the hardest-hit locations [1]. While these measures are well intended and even considered necessary in some instances, they have complicated end-of-life situations for patients and their loved ones.

The moral distress hospital staff face when choosing to enforce health and safety policies over providing patients with the closure in their transition out of life is immense. Institutions across the United States have risen to the occasion, innovating new uses for telehealth to keep patients virtually connected with their families during their hospital stays [2].

Other facilities have considered allowing a limited number of visitors given they can be swiftly tested for COVID-19, taught how to properly wear PPE, and expected to comply with proper sanitation regulations [3]. However, even this possibility comes with scrutiny: How will hospitals decide who gets to visit and who doesn’t? Will families be judged on their perceived ability to comply with protocol? And which patients will be permitted visitors?

Regardless of how hospitals choose to ease the burden of end-of-life complications during the pandemic, the decisions made today will have a long-term impact on families of those lost. Many will be left with questions about how their loved ones spent their final moments and the care they received in the hospital [4]. Some may even be left with a sour-taste in their mouths, feeling as though the policies in place to protect patients end up doing more harm than good. Now more than ever, it is imperative health care workers establish communication with families and extend empathetic guidance during the course of a patient’s hospital stay.
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While the pandemic will continue to place an extra burden on end-of-life situations for patients, families, and the healthcare team, hospitals continue to explore their options to provide adequate closure. Virtual alternatives, tightly regulated visits, and enhanced communication are only a few of the ways hospitals are challenging the ethical and healthcare dilemmas brought about by COVID-19. As hospitals become more comfortable navigating the alternatives to a traditional end-of-life process, it is the hope more patients will experience a dignified transition out of life with the support of their loved ones physically or virtually at their bedside.
 

1. https://labblog.uofmhealth.org/lab-notes/dying-alone-during-a-pandemic
2. https://www.nejm.org/doi/full/10.1056/nejmp2007781
3. https://www.webmd.com/lung/news/20200713/do-covid-19-patients-really-have-to-die-alone#2
4. https://www.verywellmind.com/the-fear-of-dying-alone-4844797

Written by: Amanda Delgado ​