Ethical challenges of providing end of life care in an Ebola treatment unit (2014-2015)
PHE ePoster Library. Draper H. Sep 12, 2017; 186503; 139
Prof. Heather Draper
Prof. Heather Draper
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Abstract Background: British military were deployed as part of the UK Government's response to the Ebola outbreak in West Africa (Op GRITROCK). This included establishing a small, well-resourced ETU for Ebola-infected international responders and local healthcare workers. End of life care (EoLC) provision in humanitarian disaster response is little discussed. Method: Twenty personnel who deployed between October 2014 and April 2015 were interviewed about the ethical challenges faced. Participants included doctors (7), nurses (6) and other healthcare related (7). A largely conventional approach to content analysis was taken using the data to draw conclusions about emerging themes emerging. Data were organized using NVivo. Only the EoLC theme is reported here. Results: EoLC caused particular ethical difficulties, even though most participants were accustomed to dealing with the dying and dead. Challenges included: balancing infection control and EoLC and comfort; uncertainty about patients' prognosis, which resulted in, amongst other things, a 'hybrid' approach to EoLC; and, competing interests. The duty to care for patients ('normal' professional obligations) was constrained by public health measures (containment) and the need to protect staff from infection (obligations to employees/self/colleagues). EoLC, where extended human contact seems especially important, was particularly impacted. Conclusions: A distinction between care and symptom relief at the EoL emerged during this mass outbreak of a highly infectious and serious disease. This was a source of ethical tension. The difficulties of providing meaningful care need to be taken into account when deciding how to prioritize and deliver EoLC in a disaster response. External funding details ESRC ES/M011763/1
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