In the Eye of the COVID-19 Storm: An Ethical Analysis on Aging, End of Life, and Recovery

Main Article Content

Al Giwa Pamela B. Teaster, Ph.D., M.A., M.S.

Abstract

Early into the COVID pandemic, epidemiologists and infectious disease experts warned that older adults were among those most vulnerable to the disease, as multiple studies from China, Italy, Washington State, and New York City showed that age greater than 65 significantly increased the risk of severe disease and/or death from the novel 2019 coronavirus. Centers for Disease Control data through June 2020 show that nearly 81% of deaths due to COVID-19 are of people 65 years of age and older. These breakdowns indicate that, primarily, persons with advanced age and most, often, those with multiple chronic conditions are those who have died. The effects of the virus led to public health measures aimed at reducing exposures of older people and other vulnerable populations.  The disease was amplified in rehabilitation centers, skilled nursing facilities, assisted living centers, group homes, and other long-term care facilities serving a primarily geriatric population. Even as parts of the country are opening up, the death toll is still climbing and affecting the older adult population disproportionately.  Duty to care, autonomy and self-determination, non-judgmental regard, justice, and futility are all significant ethical principles and constructs that have arisen in the intense and real-time application of healthcare as we continue to face the present global pandemic. We use an ethical lens to examine the medical response of the SARS-CoV-2 pandemic on the older adult population and explore if society is doing enough to protect older adults, or rather, engaging in and furthering collective and systematic elder abuse. 

Keywords: ethics, older adult, elder abuse, end of life, healthcare professional, covid-19, sars-cov-2, novel coronovirus-2019, geriatrics

Article Details

How to Cite
GIWA, Al; TEASTER, Pamela B.. In the Eye of the COVID-19 Storm: An Ethical Analysis on Aging, End of Life, and Recovery. Medical Research Archives, [S.l.], v. 9, n. 5, may 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2414>. Date accessed: 24 nov. 2024. doi: https://doi.org/10.18103/mra.v9i5.2414.
Section
Research Articles

References

1. Grabowski DC, Mor V. Nursing Home Care in Crisis in the Wake of COVID-19. JAMA. 2020;324(1):23. doi:10.1001/jama.2020.8524
2. Lau‐Ng R, Caruso LB, Perls TT. COVID-19 Deaths in Long‐Term Care Facilities: A Critical Piece of the Pandemic Puzzle. J Am Geriatr Soc. 2020;68(9):1895-1898. doi:10.1111/jgs.16669
3. CDC. Coronavirus Disease 2019 (COVID-19) in the U.S. Centers for Disease Control and Prevention. Published June 17, 2020. Accessed June 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
4. Ouslander JG, Grabowski DC. COVID‐19 in Nursing Homes: Calming the Perfect Storm. J Am Geriatr Soc. 2020;68(10):2153-2162. doi:10.1111/jgs.16784
5. Houtven CHV, Boucher NA, Dawson WD. Impact of the COVID-19 Outbreak on Long-Term Care in the United States. Published online April 2020:25.
6. Centers for Disease Control and Prevention. Elder Abuse|Violence Prevention|Injury Center|CDC. Published May 13, 2020. Accessed November 1, 2020. https://www.cdc.gov/violenceprevention/elderabuse/index.html
7. World Health Organization. WHO | Elder abuse. WHO. Published 2020. Accessed November 1, 2020. http://www.who.int/ageing/projects/elder_abuse/en/
8. Teaster PB, O’Brien JG. The Elder Mistreatment of Overtreatment at End of Life. Public Policy Aging Rep. 2014;24(3):92-96. doi:10.1093/ppar/pru025
9. Rhodes R, Alfandre D. A systematic approach to clinical moral reasoning. Clin Ethics. 2007;2(2):66-70. doi:10.1258/147775007781029582
10. Supreme Court of Minnesota. Warren v. Dinter. NW 2d 926, 370 (Supreme Court 2019).
11. Rhodes R. Understanding the trusted doctor and constructing a theory of bioethics. Theor Med Bioeth. 2001;22(6):493-504. doi:10.1023/a:1014430208720
12. Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act (EMTALA) | CMS. Published 1986. Accessed November 1, 2020. https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA
13. United Nations. POLICY BRIEF: THE IMPACT OF COVID-19 ON OLDER PERSONS. Published May 2020. Accessed November 1, 2020. https://unsdg.un.org/sites/default/files/2020-05/Policy-Brief-The-Impact-of-COVID-19-on-Older-Persons.pdf
14. Maria Sacchetti, Jon Swaine. Life Care Center of Kirkland faces $611,000 fine over lapses during fatal coronavirus outbreak | The Seattle Times. Published April 2, 2020. Accessed November 1, 2020. https://www.seattletimes.com/nation-world/life-care-center-of-kirkland-faces-611000-fine-over-lapses-during-fatal-coronavirus-outbreak/
15. Farrell TW, Francis L, Brown T, et al. Rationing Limited Healthcare Resources in the COVID‐19 Era and Beyond: Ethical Considerations Regarding Older Adults. J Am Geriatr Soc. 2020;68(6):1143-1149. doi:10.1111/jgs.16539
16. Will Englund. Covid-19 killed thousands of nursing home residents who weren’t taken to a hospital - The Washington Post. Published June 16, 2020. Accessed November 1, 2020. https://www.washingtonpost.com/business/2020/06/16/nursing-home-deaths-coronavirus-hospital-transfers/?arc404=true
17. Peisah C, Byrnes A, Doron I (Issi), Dark M, Quinn G. Advocacy for the human rights of older people in the COVID pandemic and beyond: a call to mental health professionals. Int Psychogeriatr. Published online June 3, 2020:1-6. doi:10.1017/S1041610220001076
18. Farrell TW, Ferrante LE, Brown T, et al. AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond. J Am Geriatr Soc. 2020;68(6):1136-1142. doi:10.1111/jgs.16537
19. Singh JA, Moodley K. Critical care triaging in the shadow of COVID-19: Ethics considerations. South Afr Med J Vol 110 No 5 2020. Published online April 16, 2020. http://www.samj.org.za/index.php/samj/article/view/12907
20. World Health Organization. WHO | Ageism. WHO. Published 2020. Accessed November 1, 2020. http://www.who.int/ageing/ageism/en/
21. Colenda CC, Reynolds CF, Applegate WB, et al. COVID-19 Pandemic and Ageism: A Call for Humanitarian Care. The Gerontologist. 2020;60(6):987-988. doi:10.1093/geront/gnaa062
22. Graham J. Coronavirus Patients Caught In Conflict Between Hospital And Nursing Homes. Kaiser Health News. Published March 30, 2020. Accessed November 1, 2020. https://khn.org/news/coronavirus-patients-caught-in-conflict-between-hospital-and-nursing-homes/
23. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet Lond Engl. 2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8
24. Jeremy Howick. The Unethical Damage Done by Forcing People to Die Alone. Psychology Today. Published April 26, 2020. Accessed November 1, 2020. https://www.psychologytoday.com/blog/doctor-you/202004/the-unethical-damage-done-forcing-people-die-alone
25. Arthur L. Caplan, PhD. Even Very Old People Deserve Aggressive Medical Care. Published February 18, 2020. Accessed November 1, 2020. https://www.medscape.com/viewarticle/924329
26. Giwa AL, Desai A, Duca A. Novel 2019 coronavirus SARS-CoV-2 (COVID-19): an overview for emergency clinicians. Pediatr Emerg Med Pract. 2020;17(5):1-24.
27. Zucker HA, Adler KP, Berens DP. Current Members of the New York State Task Force on Life and the Law. Published online November 2015:272.
28. Poston JT, Patel BK, Davis AM. Management of Critically Ill Adults With COVID-19. JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4914
29. Palermo-Fabris E, Piccinni M, Zatti P, Casonato C, Barbisan C. GRANDI INSUFFICIENZE D’ORGANO “END STAGE”: CURE INTENSIVE O CURE PALLIATIVE? “DOCUMENTO CONDIVISO” PER UNA PIANIFICAZIONE DELLE SCELTE DI CURA. Published online April 22, 2013:48.
30. Cesari M, Proietti M. COVID-19 in Italy: Ageism and Decision Making in a Pandemic. J Am Med Dir Assoc. 2020;21(5):576-577. doi:10.1016/j.jamda.2020.03.025