131:oral Where should we draw the line?’ A qualitative study of ethical dilemmas amongst nursing home doctors during the first half of the COVID-19 pandemic

Nursing homes in Norway have carried a heavy burden during the Covid-19 pandemic. They had the most virus related deaths, and strict rules for visits, testing and isolation. They had to follow a clear priority to prevent unnecessary hospital admissions in order to not overburden the hospitals. This study explores the ethical dilemmas as experienced by doctors working at nursing homes during the first half of the pandemic.

Method

Qualitative analysis of nine in-depth interviews with doctors working at five different nursing homes in Bergen, Norway. Analysed by Attride-Stirling thematic network analysis.

Results

Our study found that ethical dilemmas at nursing homes were enhanced by the pandemic. Admitting a sick resident to the hospital became a trade-off between what doctors were capable of handling versus the priority guidelines to prevent unnecessary admissions. End-of-life care for Covid-19 residents was a balance between administrating a high enough doses of morphine to alleviate suffering though making sure the dose was not lethal. Since dying residents were allowed visitors, it became a dilemma to define when a patient was dying. Strict rules regarding visits were challenging as the risk of getting the virus into the nursing home had to be weighed against residents wellbeing. Coercive measures for testing and isolating residents had to be assessed against the real need for doing such tests.

Discussion

Dealing with ethical dilemmas at nursing homes during the pandemic has been challenging. Are we doing more harm than good when enforcing strict rules for visits in an effort to prevent the virus from entering nursing homes? Is it okay to do coercive testing and isolation in order to curb the spread of the virus? Are we doing good if the only way to alleviate suffering at end-of-life treatment for Covid-19 residents is through a lethal dose of morphine?