Care Synergy is a network of not for profit community-based hospice, home health, and palliative care organizations serving Colorado’s Front Range.

When Care Synergy’s network of Colorado nonprofit hospice, palliative, and home health care providers formalized a joint ethics committee in 2019, no one was expecting the panel would soon be responding to the dilemmas posed by a once-in-a-lifetime viral pandemic.

But leadership at the five Affiliates of Care Synergy have found the ethics committee to be an invaluable resource, especially when facing the new challenges posed by COVID-19, .

“These were really significant issues that we were facing. For me and the President at each Affiliate organization it was important to have participation and feedback from the entire team, and this was a great way to do it. We want to make the best decisions for everybody – for patients, families, physicians, nurses, and our community. This forum presents that opportunity,” said Tim Bowen, President and CEO of Care Synergy. The Care Synergy network also includes the Colorado Visiting Nurse Association, Halcyon Hospice & Palliative Care, Pathways, and Pikes Peak Hospice & Palliative Care.

The Important Role of an Ethics Committee

Ethics committees are considered a best practice in health care and are used by high-quality providers to offer direction when organizations and/or their staff are faced with situations in which there are no simple, clear-cut answers.

“Some things that come up frequently are situations like when a patient is unresponsive and the family doesn’t want to give pain medication, but the staff see the patient writhing in pain. So the family and staff are both trying to do what they think is right,” explained Melissa Davis, chair of the Care Synergy Ethics Committee and a licensed clinical social worker at The Denver Hospice.

The Committee includes doctors, nurses, social workers, Chaplains, and community members from all of the Affiliates. It has standing quarterly meetings, but is usually called together more frequently to respond to requests for immediate consultation as issues arise. Those requests can come from any member of an Affiliate’s community. Those involved in the question posed, such as family and staff, are invited to attend the meetings and to contribute their perspectives.

“When we talk with staff, we talk about the ‘ick’ factor. That is, if you are feeling ‘icky’ about a situation, are just not comfortable with some aspect of it, that’s the time to talk to your manager or to call me directly. It might be that an ethics consult is appropriate,” said Davis.

Ethics committees provide recommendations based on the consideration of many biomedical ethical principles. Some examples include the principle of autonomy (the right to make informed decisions for ourselves), the principle of non-maleficence (commonly known as “first do no harm”), and the principle of beneficence (the obligation to promote good to benefit others).

Davis says no one principle is more important than another, so when they conflict it’s important to consider a situation from multiple perspectives. That is one of the key benefits of Care Synergy’s joint ethics committee.

“We have brought together some of the brightest minds and most diverse perspectives by pooling our committee this way. The benefit is getting so much knowledge and experience with representation from all over Colorado,” said Davis.

The Care Synergy Ethics Committee During COVID-19

When concern about COVID-19 reaching Colorado first surfaced, the Care Synergy Ethics Committee met immediately to begin discussions about the best ways to respond. At one of the early meetings the committee considered several hypothetical scenarios, such as: what to do if a nurse refuses to treat COVID-19 patients, or what to do if a COVID-19 patient is having an urgent pain or symptom crisis but a nurse doesn’t have personal protective equipment at that moment?

“Even though these were hypotheticals at the time, during the pandemic our affiliates, like most health care providers, later faced these issues or some variation on these themes,” said Bowen.

As more information about COVID-19 became available and as the situation evolved, the Care Synergy Ethics Committee revisited the earlier questions. Today, the Committee continues its work as new questions arise. Davis says discussions around COVID-19 will continue for years among bioethicists, as retrospect allows them to consider how the medical community responded and what can be learned for the next time.

“I feel like it’s a real service to our community. It’s not just another bureaucratic meeting. The people on the ethics committee are donating their time to serve the community, to serve those individuals who are almost always, in situations like these, in crisis,” said Davis.