{"id":48449,"date":"2020-08-28T14:06:58","date_gmt":"2020-08-28T13:06:58","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48449"},"modified":"2020-09-07T10:47:13","modified_gmt":"2020-09-07T09:47:13","slug":"they-also-serve-who-only-stand-and-wait-ethical-and-spiritual-response-to-the-covid-19-pandemic","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/28\/they-also-serve-who-only-stand-and-wait-ethical-and-spiritual-response-to-the-covid-19-pandemic\/","title":{"rendered":"They also serve who only stand and wait: Ethical and spiritual response to the covid-19 pandemic"},"content":{"rendered":"

John Milton\u2019s sonnet \u201cOn his blindness,\u201d expresses the sense of powerlessness, frustration, and even guilt that many feel in responding to situations beyond their control, where their ability for active participation to act from the common good is limited. [1] We applaud and respect the considerable efforts and sacrifices made by those who provide public services in the face of covid-19 especially those frontline workers in health and social care roles.\u00a0<\/span><\/p>\n

There have been heartfelt expressions of support and solidarity e.g. volunteering initiatives such as transporting patients, delivering drugs and equipment, telephone support, community responses or simple acts of kindness. [2] In this situation where so many are trying to help what part might ethical and spiritual services play?<\/span><\/p>\n

As well as physical, social, and economic effects, pandemics and our responses to them, provide ethical challenges. The latter pose risks of moral distress, either with individuals knowing the right course of action, but constrained by lack of resources or with conflict over what course of action is right. [3] If the negative effects of exposure to morally distressing situations is prolonged and cumulative as during a pandemic, moral injury may result, and has been correlated with compassion fatigue and burnout. [4]<\/span><\/p>\n

The causes of moral distress are numerous, but a major factor on the healthcare response to pandemics relates to the changing ethical imperatives that providing care for large numbers of sick people brings. In most healthcare systems, professional duty is defined by the principle of making the care of individual patients the primary concern. [5] In pandemics, there are tensions between this individualised approach based on clinical need and duties to the wider population in terms of minimising harms and maximising benefits. Deciding on what care is provided shifts from consideration of an individual\u2019s needs, to whether s\/he is likely to especially benefit from the intervention. This tension creates moral dilemmas when resources (staff, beds, equipment) are limited, yet urgent and frequent existential decisions have to be made, with the usual uncertainty over outcomes. These decisions are challenging, but nonetheless necessary, with some professionals needing to act out-with their usual areas of expertise.<\/span><\/p>\n

Consequently, a number of professional bodies have provided ethical frameworks for <\/span>policy making and decision-making<\/span>, some specific to covid-19<\/span>. [6,7] As helpful as these may be at the meta policy-making level, they do not usually indicate what practical support ethics and spiritual care may provide. A traditional view on ethics support is that it has the role of a chorus in a Greek tragedy <\/span>by offering advice history and support for the protagonist: <\/span>“Its virtue is its presence and its sympathy and its clear meditation on his or her predicament in a social and historical context.\u201d [8] It may also function as a moral memory to be recalled in future events. This important reflective, but largely reactive, role has been superseded and the practical input from ethics and spiritual services in alleviating moral distress and preventing moral injury are increasingly recognised.\u00a0\u00a0<\/span><\/p>\n

The need for a later return to a healthcare profession not broken by the experience of covid-19 has been underappreciated as yet.<\/span><\/p>\n

In terms of local more individualised responses to the covid-19 pandemic, ethics support services can:<\/span><\/p>\n