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- Title
Patterns of Clinical Ethics Consultation Before and After the Initial COVID-19 Surge in New York City.
- Authors
Yolanda Yu; Horton, Breckin; Hulkower, Adira; Lipman, Hannah I.; Chuang, Elizabeth
- Abstract
Background: Since the COVID-19 pandemic, clinical ethics consultation services have faced new challenges such as medical decision-making in the setting of unprecedented resource and staffing shortages and increased public mistrust of the healthcare system. This study aims to analyze shifts in consultation patterns due to long-lasting consequences of the pandemic in a healthcare system in New York City. We hypothesized an increase in consults placed for refusal of medical treatment due to heightened public distrust. Methods: We used the clinical ethics consultation service database to extract data on volume and reason for consult. Consults placed between 2015 and 2021 were included, except those placed during the height of the COVID-19 surge in March and April 2020. Chi-squared tests were used to compare the proportion of consults requested for each ethical issue between pre-COVID and post-COVID cohorts. Logistic regression was used to compare proportions of consults between the cohorts while controlling for confounding demographic variables. Results: 547 consults in the pre-COVID cohort and 215 in the post-COVID cohort were included. There was no significant difference pre- and post-COVID in the proportion of ethics consults placed for refusal of medical care in either the unadjusted or adjusted analysis (27% and 24% respectively). There were some statistically significant differences in other categories of consultation, however the absolute numbers were small. Conclusions: Our findings did not support the hypothesis that increased public mistrust in the post-COVID era has increased consultations related to refusal of recommended medical care. Perceptions of increases in refusal of medical care may be related to overall increases in clinician moral distress and emotional fatigue.
- Subjects
UNITED States; HEALTH services accessibility; MEDICAL ethics consultation; PSYCHOLOGICAL burnout; LOGISTIC regression analysis; MEDICAL care; POST-acute COVID-19 syndrome; DECISION making in clinical medicine; DESCRIPTIVE statistics; CHI-squared test; ETHICS; LONGITUDINAL method; PATIENT refusal of treatment; PUBLIC health; COMPARATIVE studies; COVID-19 pandemic; PATIENTS' attitudes; MEDICAL ethics; LABOR supply
- Publication
Journal of Hospital Ethics, 2024, Vol 10, Issue 1, p18
- ISSN
1938-4955
- Publication type
Article