The FAMCare Blog

Triage...A Moral Dilemma

Posted by GVT Admin on Aug 12, 2020 2:59:10 PM

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The Covid-19 Pandemic has overwhelmed hospital emergency rooms in many of America’s largest cities forcing doctors and nurses to find themselves in triage mode perhaps for the first time in their careers.

tri·age
/trēˈäZH/
(in medical use) The assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties.

a: The sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors.
b: The sorting of patients (as in an emergency room) according to the urgency of their need for care.

Triage During the Pandemic

“Does triage mean that if I show up at the emergency room with covid symptoms and the hospital is full, they might decide to turn me away?”

That’s exactly what triage currently means in the wealthiest most advanced country in the world. To most Americans, it is unimaginable.

“Why me? Who decides?”

The doctors in charge decide when and how triage principles will be applied. So far, during this pandemic, the decision point has focused on patients who will most likely survive corona virus with hospital care. This means that old people and patients with severe comorbidities will be turned away when the hospitals can take no more. Needless to say, many health care workers disagree with this decision and are deeply distressed by their imposed role in covid triage.

One emergency room nurse expressed her distress in these two simple questions:

  1. "How will we ensure that people with disabilities are not denied care simply by virtue of their disability?"
  2. "How can we ensure that implicit (or even explicit) bias does not drive triage decisions?"
The Moral Dilemma

In health care there are often barriers that counteract an individual’s desire to express moral courage. These barriers include organizational culture, lack of colleague concern, loss of independent thinking, and redefining unethical acts as acceptable. Professionals in the health care hierarchy are often unaware of how their decisions affect their front-line workers on a moral, emotional, intellectual, and professional level.

Social Worker’s Role

  • Triage decisions need to be made in the moment. Hospitals are already discussing the guidelines, and social workers working in hospitals have a responsibility to be involved in the policies addressing access in this emergency. They can serve on ethics committees or volunteer to work on the committee designing the policies. They can even advocate for individual patients.
  • Social workers are equipped with a unique skill set that qualifies them to become leaders in demonstrating moral courage. It is vital to allow professionals to reflect on their own experiences and their associated impact—personally, professionally, or both. This can facilitate open discussion of the skills necessary to combat moral distress and support morally courageous behaviors. Social workers are ideal candidates to lead such interdisciplinary discussions, as their education and training includes the skill set for group work and mediation.

In all aspects of the social work field these professionals often stand up against the majority, advocating for those who cannot advocate for themselves. The moral resilience of social workers is what makes them stand out in any climate of conformism.

Topics: social workers, healthcare issues, Covid-19, Frontlines, emergency room

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