Impact of COVID-19 social distancing on the quality of dying: A call for discretionary application of rules

During the COVID-19 pandemic the media and the regulators have given limited attention to the impact of social distancing rules on the quality of living and dying, not only for COVID-19 patients, but for anyone who has reached the end of life from natural causes in hospitals and residential aged care facilities (RACFs). Fear for the safety of other patients, visitors, and healthcare clinicians during the pandemic (Gordon et al., 2020), triggered unprecedented isolation practices including limiting staff numbers attending to patients, transitioning to virtual rounds (Arora, Chivu, Schram, & Meltzer, 2020), restricting hours and duration of visiting, isolating patients in ICU at end of life, and enacting policies on numbers of bedside family/caregivers who can accompany terminal patients (Wakam, Montgomery, Biesterveld, & Brown, 2020). In some institutions, nursing staff, and social workers on shift are taking the place of families, providing a compassionate presence to dying patients: others are dying unaccompanied. Unfortunately, these extraordinary circumstances place an immediate and ongoing emotional burden on clinicians and families alike. While it is true that people will eventually adapt and that those of us who lived through the pandemic will recover from the shock and unexpected changes to our lifestyle and clinical practice, many who lost loved ones without a proper farewell due to draconian health service rules will experience prolonged, complicated grief responses, post-traumatic stress (Selman et al., 2020) and separation distress (Gesi et al., 2020). Meanwhile the strict rules have caused clinicians job dissatisfaction, and moral distress (Canadian Medical Association, 2020). The quality of dying has been negatively impacted. The ethical dilemma for clinicians is reconciling the need for compliance with internal policies and the competing need for holistic management of the individual.