CCBI Resources for Covid19 – February 5, 2021

Dear Friends of CCBI,

Last week we said we wanted to pay more attention to mental health issues exacerbated by COVID-19, since problems in this area are surfacing exponentially. We are aware that all the areas we cover have serious and numerous implications, and we are but touching on them in some cases, raising bioethical and social justice issues in the field of bioethics, while not attempting to cover all of them in depth. We simply hope to encourage wider reading, to sharpen awareness of these issues and to lend a note of hope to our Catholic perspective, in line with our mission.

Regarding mental health, there has been a good deal of research on the effects of the second wave of the pandemic, one of them being a nationwide monitoring survey by the Canadian Mental Health Association (CMHA) in partnership with UBC researchers, released in December, 2020. Even before winter was in full force, the report (below) showed that, “40 per cent of Canadians say their mental health has deteriorated since March, with the decline more pronounced in those who are unemployed (61 per cent), those with a pre-existing mental health issue (61 per cent), younger people ages 18-24 (60 per cent), Indigenous peoples (54 per cent), those identify as LGBTQ2+ (54 per cent) and those with a disability (50 per cent). Almost half of women (45 per cent) and a third of men (34 per cent) say their mental health has declined.” The CEO of the Canadian Mental Health Association, Margaret Eaton, warned that this situation would worsen in extreme cold, which might restrict outdoor exercise, cause distress in families which would be ‘cooped-up,’ and cause further anxiety about slipping and falling, especially among seniors. Added to that, Christmas holiday gatherings were restricted, not only reducing ordinary family contact, but leading to a rise in depression and anxiety, caused by loneliness and lack of basic human contact.

Particularly worrying about the survey was that it reported: “Of great concern is the sharp increase in suicidality this fall, with one in 10 Canadians (10 per cent) experiencing recent thoughts or feelings of suicide, up from six per cent in the spring and 2.5 per cent throughout pre-pandemic. Suicidal thoughts and feelings are even higher in various subgroups of the population, including those who identify as LGBTQ2+ (28 per cent), with existing mental illness or mental health issues (27 per cent), with a disability (24 per cent), ages 25-34 (21 per cent) and 18-24 (19 per cent) and who are Indigenous (20 per cent).” These latter groups are clearly in need of specialized services, but, as the pandemic has revealed in so many areas and the Faculty of Medicine at UBC states: “The new research also shows that few Canadians are getting mental health services and supports they need, while many are relying on a combination of healthy and unhealthy strategies to cope.” Eaton points out: “Even before the pandemic, the mental health care system in Canada was not meeting people’s needs due to long waitlists, access issues, inequity and underfunding…Lengthy wait times are a problem, in part, because there has been a chronic underfunding of community-based mental health services and a reliance on intensive, high-cost services like hospitals and acute care. If we fund community-level interventions, this will alleviate pressure on an acute-care system already hit hard by COVID-19—and get people the help they need sooner.”

Social, structural and funding responses to mental health issues have long been needing more focused government attention, and the price to be paid for this neglect is sadly taking a further toll on all parts of our population, especially on those already the most vulnerable. We plan to comment further on these issues – we need to do so in our Church at large.

Another difficult ethical issue still exists about the question of using resources optimally during the pandemic, any time it looks as if our ICUs could be overwhelmed, with not enough ventilators (and sometimes staff) to fill the need. This question arose during the first wave, but mercifully our hospitals were able to cope. The second wave has been threatening to tip over the balance, but at the minute declining numbers are helping to ease the problem. Most of the population has worked hard to prevent matters reaching the stage of having to decide who would receive ventilator treatment and who would not, as happened in Italy during its first wave, when people were caught unaware and unprepared. An article in the National Post presents a decision-making scale for such times. Sharon Kirkey’s National Post article looks at some hospital policies that talk about ‘randomization’. This means that doctors would not decide, but patients’ names would literally be chosen by chance, like drawing a raffle ticket. One doctor said: “But far worse than a random number generator would be a human being having to choose,” since that doctor would have to live with the consequences, which would be understandably traumatic. Yet the concept of ‘triage’ is based on qualified people rapidly deciding in desperate situations which patients would most benefit from treatment. While recognizing that every approach in such conditions could bring unwanted results, it seems to me that an experienced physician is likely to be right more often than a random number generator and that the usual approach should continue.

We’ve attached a short paper I wrote during the first wave which emphasizes that the only non-discriminatory approach in situations where not all patients can be treated is to assess the underlying health conditions and, based on those, decide who would likely benefit from ventilator use, and who would not. Of course, this is imperfect, but based on reason, not random choice. Please God it never comes to having to make those decisions! Physicians and healthcare workers should never be faulted for doing the best they can in impossible situations, and they deserve societal support.

Pope Francis has been drawing attention to ways of coping with the pandemic since it began. His Wednesday Audiences are intended to help us pray our way through these times and to take concrete, social action where possible. Vatican News‘ report on the Pope’s new book, To Heal the World, relates: “His discourses touch the root of social injustice, the importance of the preferential option for the poor, healing social pandemics and countering attitudes of indifference. They also recall the universal destination of goods and how inequality is the result of unequal economic growth. Central to this journey are solidarity and empowering local people, as well as the call to put oneself at the service of building a “civilization of love” that promotes the common good at all levels.” Based firmly on the four pillars of Catholic Social Teaching (Dignity of the individual, the common good, subsidiarity and solidarity) it is a challenge to our societal and personal indifference to these injustices. The Pope has been pointing out for some time that we must not return to our old ways after the pandemic is over, but should chart a new course to tackle social justice issues systematically in order ‘to heal the world.’ He knows we are much more aware about issues than before; shocking revelations about long-term care homes, mental health issues, employment issues in all sectors of the population, etc., have been forced upon us even if we would prefer to turn a blind eye. The Pope is turning us once more to listen to the Word: “Repent and believe the Good News!” Can we claim to believe and not repent? “To Heal the World” depends to a great extent on those who believe in the true Healer. While it is hard for us to see the Pope’s urging in its fulness while the pandemic is still upon us, it does provide thoughts and insights for re-structuring the future, a message of hope for many in itself.

Our Lady, Health of the Sick, pray for us!

We pray for women who are victims of violence, that they may be protected by society and have their sufferings considered and heeded!

(Pope Francis’ Intention for the month of February)

Moira and Bambi

Canadian Mental Health Association
Summary of Findings Mental Health Impacts of COVID-19: Wave 2
Summary of Findings . Mental Health Impacts of COVID-19: Wave 2. Self-reported change to mental health. cmha.ca

The University of British Columbia (UBC)
New national survey finds Canadians’ mental health eroding as pandemic continues – UBC Faculty of Medicine
The new research also shows that few Canadians are getting mental health services and supports they need, while many are relying on a combination of healthy and unhealthy strategies to cope. www.med.ubc.ca

National Post 
A plan of last resort: Choosing who lives and dies if ICUs turn into virus war zones
It may sound dystopian and dehumanized. But far worse than a random number generator would be a human being having to choose who gets life-saving treatment nationalpost.com

Canadian Catholic Bioethics Institute – Dr Moira McQueen

Vatican News
“To Heal the World”: The Pope’s Catechesis on the Pandemic