Ethical Issues Surrounding the Presence and Absence of Loved Ones for Patients Undergoing End-Of-Life Care During a Pandemic
With the arrival of the pandemic in March 2020, Quebec significantly restricted the presence of family members with patients in the health and social services network. Many people at the final phase of life died alone, without comfort, basic care, or accompaniment, in conditions that are inconsistent with palliative care’s philosophy. The gap between the first two waves of the pandemic allowed the government to conduct a retrospective examination of the issue. The ministère de la Santé et des Services sociaux (MSSS) called for a greater contextualization of the guidelines issued on the visits, recognizing the importance and the role that relatives play in the life and care of patients. Based on the comments of patients, loved ones, caregivers, and management, we share our thoughts and observations as clinical ethicists. Specifically, we analyze three ethical issues related to the presence or absence of relatives: inequity arising from varying interpretations of directives, moral distress, and the blocking of values for end-of-life care. We propose an integrated approach and discuss how communication can mitigate these issues. Finally, we present how clinical ethics services can support end-of-life health professionals, management, relatives, and patients in resolving issues surrounding visits.