Let compassion govern VA hospital policies for dying COVID patients

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Fifteen years ago, while deployed as an infantry officer to Iraq, I watched friends in battle expose themselves to considerable dangers while pulling injured soldiers to safety. There was an unspoken expectation that one would risk one’s life to save that of a brother or sister in arms. That was, perhaps, the good to be found in the otherwise ugly world of combat. One knew, no matter what happened, you would never be abandoned.

This helps explain why I was so upset to learn that policies governing end-of-life visits to Veterans Affairs (VA) hospitals, designed to reduce potential exposure to COVID-19, are an inconsistent hodgepodge of restrictions, often lacking scientific or rational justification and compounding the emotional distress that patients and their families experience.

A few weeks ago, I received a Facebook update from my local VA hospital in Pittsburgh — where my wife and I received our COVID vaccinations and were impressed by the staff’s selfless service — explaining that “visits to all inpatients, including those at end of life, are prohibited if they are COVID-positive.” I was shocked and asked how they could justify these restrictions. A hospital official explained they try to accommodate “virtual” visits for those with COVID who are dying.  

Forcing a veteran to say a final goodbye to loved ones via Zoom? I felt compelled to draw attention to such a pitiless policy.

I asked the hospital to explain the rationale. Then the hospital informed me they had reversed course; now COVID-positive patients at the end of their lives can receive two visitors over age 18. They explained that hospital policies are “evaluated constantly by an interdisciplinary team of experts and are based on community and hospital transmission rates, supply availability, and staffing availability.” I am gratified that they made the change; I kept imagining someone alone in an antiseptic hospital room, looking at a clock during their final moments, unable to look into the eyes of those they loved most or to feel the warmth of their reassuring embrace.

Curious about policies in other VA hospitals, I discovered that many remain at odds with science or common sense. Several VA hospitals allow limited visits to dying COVID-positive patients but set age limits prohibiting children. How would you explain this to a child who is desperate to see her father, or to her father who would give anything to hug his little girl one last time?

Not only is this kind of policy cold, but it appears contrary to the science that says young children are at lower risk of COVID than older persons. A recent study of children in Germany found that no healthy child, ages 5 to 17, died of COVID during a 15-month period when nearly all were unvaccinated.

The Cleveland VA hospital limits end-of-life patients to two visits, no more than 15 minutes each, while a VA in Indiana allows two visitors for “one hour total on anticipated date of death or preceding 72 hours.” Is COVID more contagious in the 16th minute in Cleveland, but not until the 61st minute across the Ohio border in Indiana? And what about the family of a dying veteran with three kids — who gets to visit?

Many policies are predicated on the assumption that time of death can be predicted with some accuracy, which of course is often not the case. A recent study of end-of-life VA care included testimonials from families who were devastated when loved ones died alone, before they could receive visitation approvals. The study concluded that this “could result in long-lasting and detrimental effects, including symptoms such as depression and anxiety, and an increased risk of complicated grief,” before suggesting these policies be reconsidered.

Perhaps restrictive policies could have been defended a year ago, before the availability of COVID vaccines and treatments and the ascendance of the omicron variant, which seems to cause less severe illness. But now they seem unnecessarily cruel.

Who, exactly, might they protect? Other patients? Though there is a risk that patients might be exposed to and contract COVID incidentally from the small number of additional visitors making their way to see dying relatives, this seems exceedingly unlikely — and no greater than their risk of exposure from anyone else they might encounter. The concern about visitors is also less convincing considering recent Centers for Disease Control and Prevention (CDC) guidance authorizing COVID-positive health care professionals to return to work during staffing shortages.

That leaves the risk for staff. But even this makes little sense, unless the medical staff are always quarantining at home when not working, and not interacting with others in any other facet of their lives. Yet, the dying veteran’s doctor or nurse could have attended a hockey game the previous night, with thousands of other unmasked screaming fans, or had beers and burgers at a crowded restaurant, before going to work the next morning and informing a son that he cannot enter his mother’s room for her final moments.

Don’t get me wrong, health care workers should be able to lead normal lives like the rest of us. If they are vaccinated, it’s likely that they accept more risk of serious injury driving to work than from possible exposure to someone with COVID.

I am often surprised when I raise concerns about arbitrary policies such as these to hear others brush them aside with some variation of “It’s not my problem” or “Who am I to object to the experts?” Perhaps our fruitless war in Afghanistan offers a cautionary tale of what can happen when society looks the other way. For 20 years, the war didn’t impact most Americans, who seemed content to defer responsibility for their country’s foreign policy to the trusted “experts” — decorated generals — who confidently recommended staying the course, adding troops and spending money, even as evidence pointed to the tragic, wasteful folly of such a strategy.

If we as a society don’t push back on policies such as those of the VA that appear to lack rational justification — and may even hurt those without influential advocates — misguided policies will endure, and more people may suffer. When hospital staff are vaccinated, and virtually everyone else could be vaccinated, shouldn’t the presumption in end-of-life matters be for policies of compassion and humanity? Restrictions should require compelling scientific or operational evidence and support. 

As the experience of combat teaches, there are things even more valuable than pursuing absolute safety — things such as courage, compassion and love. If soldiers can be expected to overcome fear to expose themselves to the risk of imminent death to save their comrades from dying alone in combat, the least we can do back home is to allow loved ones to be together in those precious moments before death.

Will Bardenwerper served as an infantry officer in the Army, and later as a Presidential Management Fellow in the Office of the Secretary of Defense. He is the author of “The Prisoner in His Palace: Saddam Hussein, His American Guards, and What History Leaves Unsaid.” Follow him on Twitter @WBardenwerper.

Tags COVID-19 policies Department of Veterans Affairs end of life care VA hospitals

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