Impact of COVID-19 social distancing on the quality of dying: A call for discretionary application of rules

The physical and psychosocial consequences of COVID-19 are still difficult to estimate and it is clear it will take the world years to fully realise and recover from. In hospitals and residential aged care facilities, the impact of the social distancing rules on the quality of living and dying, not only for COVID-19 patients, but for anyone who has reached the end of life from natural causes has not received special attention. Restriction on number of visitors, visiting hours, border closures and varying institutional policies across public and private health systems has created confusion, distress and anger, as it meant that some patients died alone, families lacked closure, or the sole visitor present at a death was without the comfort of a companion. We argue that in health systems that are not overwhelmed by a surge of cases, it is reasonable to ensure that clinicians apply consistent discretion of compassionate concessions to allow a dignifying farewell without posing additional risks. Policies need to cater for a diversity of situations, and where feasible, clinicians have a duty to prevent long-term complicated grief by meeting the families’ psychosocial needs through a more humane, person-centered care solution.