Hong Kong Med J 2020 Oct;26(5):463 | Epub 9 Oct 2020
Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
LETTER TO THE EDITOR
Self-reflections after disbandment of palliative
care unit during COVID-19 pandemic
PT Lam, MB, ChB, FHKAM (Medicine)
Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
Corresponding author: Dr PT Lam (lampt@ha.org.hk)
To the Editor—With large number of deaths in
many countries owing to the coronavirus disease
2019 (COVID-19) pandemic, there is a place for
palliative care to alleviate suffering and uphold
dignity for these patients.1 However, the small
number of deaths and the primary goal to save lives
has limited the referral of patients with COVID-19
in Hong Kong for palliative care. Nevertheless,
medical professionals should be well prepared to
serve those who would die of COVID-19 as well as
from unrelated causes.2
Without palliative care units, although patients
with advanced life-limiting illnesses could be
admitted to acute medical beds with support from
the palliative consultative service, the aggressiveness
of medical treatment and provision of compassionate
care might not be appropriate in acute settings. This
can jeopardise the quality of care, especially for
patients with complex needs, challenging symptom
burden, and complicated grieving families. Thus,
both palliative in-patient and consultative services
are complementary and both are needed in acute
hospitals.3 There is ample evidence that palliative
care provides good outcomes, including better
quality of life, shortened length of stay in hospital,
increased home death, and more cost-effective acute
care.4 5 6 Deprioritising palliative care would imply
that the local health authority overlooks the holistic
needs of people with life-limiting illnesses.
The initial strategy adopted by the Hospital
Authority for quarantining all patients with
COVID-19 in acute hospitals, regardless of their
disease severity, was successful in containing the
spread of virus. However, for patients with COVID-19
and only minor or no symptoms, compulsory home
or camp quarantine with ambulatory medical
support may achieve equal success, sparing the well-equipped
cohort wards and intensive care units for
those in serious and critical conditions, without
sacrificing patients with other medical conditions.
A blanket method of rationing in which
individuals are categorised according to factors
such as age, physical or mental disability, or those
under palliative care, should not be adopted during
a pandemic.7 8 Categorical exclusions may be
interpreted by the public to mean that certain groups
of patient are “not worth treating”, leading to the
perception of unfairness and distrust. Palliative care
patients are often the most vulnerable and neglected
group in the medical field. Nevertheless, palliative
care is about more than medical treatment. A case-by-case approach is a better and more humane way to preserve the dignity of all groups of patients.
Author contributions
The author drafted the letter. The author approved the final version for publication and takes responsibility for its accuracy
and integrity.
Conflicts of interest
The author declared no conflicts of interest for the authorship and publication of this letter.
Funding/support
This letter received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
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suffering and upholding dignity in the midst of CoViD-19
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