key: cord-1031759-uj4ym1kt
authors: Oliver, Jill; Chidwick, Paula; Forsyth, Pamela; Chauhan, Nipa; Nitti, Theresa; Yu-Hin Siu, Henry
title: Ethical Considerations during COVID-19: Informed consent cannot be made in advance.
date: 2020-10-16
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.10.013
sha: 3217ce86cc111fc834e24e07c7519de825ed9d6b
doc_id: 1031759
cord_uid: uj4ym1kt

Brief Summary: COVID-19 emphasized the importance of LTC physicians using individualized proposals when a healthcare decision is required, to ensure wanted and beneficial treatment, and proper resource utilization.

To the Editor, 1 Older adults in long-term care (LTC) are at the highest risk of mortality from COVID-2 19. 1 Ontario statistics from September 15, 2020 have confirmed 1.824 LTC resident deaths, or 3 65% of all Ontario's COVID-19 related deaths. 2 At the peak of the first wave in mid-May, over 4 260 Ontario LTC homes had an active outbreak. 2 On July 29 th , 2020, the province of Ontario being proportionately more strict as system pressure increased during the pandemic. This 10 protocol used the Clinical Frailty Scale (CFS) 5 , amongst other clinical scenarios, to establish 11 exclusion criteria for ICU admission at each triage level. Specifically, patients with CFS scores 12 of greater than or equal to seven, greater than or equal to five, and greater than or equal to three 13 would be excluded at level one, two or three triage respectively. These CFS scores were chosen 14 as triage cut-offs as they would exclude those people with greater than 80%, 50% and 30% 15 predicted mortality, respectively. Thankfully, our province's healthcare system was never over 16 capacity and the protocol was never implemented. The protocol's existence did, however, cause serves as useful reminder to LTC homes that they must prepare and provide due diligence for 72 every resident whenever a healthcare decision is required. 

The Coronavirus and the Risks to the Elderly in Long-Term 91

Office of the Ontario Premier. Ontario Launches Independent Long-Term Care

Clinical Triage Protocol for Major Surge in COVID Pandemic

A global 101 clinical measure of fitness and frailty in elderly people

Transfers of LTC residents to hospital EDs: an ethics quality 103 improvement project to minimize non-beneficial and unwanted hospital transfers and 104 maximize system efficiency

The PoET (Prevention of Error-Based Transfers) Project. Healthc Q

Communication and Care Planning in the Era of the COVID-19 Pandemic

Comments on Substitute Decision-Maker (SDM) Please check the most appropriate box: As per Ontario's Health Care Consent Act

The authors would like to acknowledge that the Treatment Proposal Template was originally developed by Melissa Devlin for use in acute care settings, and was adapted by the PSSP team for use in long-term care homes. Additionally, the authors acknowledge Preet Gandhi for technical support during manuscript submission.

This document is intended to be used by health care providers who are proposing a treatment plan for a longterm care resident when that long-term care resident is not capable of making the decision on his or her own behalf. Once completed, this form will contain information that the resident's substitute decision maker should possess before making a consent-related decision about the plan on behalf of the resident.This form can be used to provide information to any substitute decision maker on the hierarchy included in Section 20(1) of Ontario's Health Care Consent Act, but might be particularly helpful when consent is being sought from the Office of the Public Guardian and Trustee.This treatment plan is being proposed for: