Systems of Care in Crisis: The Changing Nature of Palliative Care During COVID-19

Abstract

Among the far-reaching impacts of COVID-19 is its impact on care systems, the social and other systems that we rely in to maintain and provide care for those with "illness." This paper will examine these impacts through a description of the influence on palliative care systems that have arisen within this pandemic. It will explore the impact on the meaning of care, how care is performed and identified, and the responses of palliative care systems to these challenges. It will also highlight the current and potential future implications of these dynamics within the unfolding crisis of this pandemic. We look towards each other no longer

From the old distance of our names;

Now you dwell inside the rhythm of breath,

As close to us as we are to ourselves.

(John O’Donohue, “On the death of the beloved”)

Evident within the many lessons that the novel coronavirus (COVID-19) pandemic has taught us is the fragility of the systems that enable us to care for each other. Care systems, the dynamic interconnections and processes involving care providers and care recipients, result in the practices that we recognize as “care.” These systems emerge from the needs of human bodies, the recognition and response to these needs by people and communities, the communication that supports these connections, and the meaning attributed to this care. These care systems are complex and develop through relationships and interactions (Hodiamont et al. 2019). We cannot understand them or predict their movement just by focusing on the individual parts (such as the people) involved (Glouberman and Zimmerman 2004). They are also adaptive. These care systems are influenced by and respond to the changes that occur within and around them, sometimes resulting in the emergence of new behaviours and approaches. Response can lead to some systems becoming more resilient to change and to other disrupting or even dispersing. How care is provided within and through these systems varies. But such systems remain an omnipresent shifting and often unnoticed tapestry of connections and structures engendering our experience (Maturana and Varela 1980).

As is true for so many of our current global experiences, it is no surprise that care systems have been affected by the threat or presence of COVID-19. COVID-19’s primary direct impact is within the physical systems (the bodies) of infected people. However, this initial systemic, bodily impact of COVID-19 in individuals has consequences for other systems resulting in the social, psychological, and community impact of this crisis. These systemic changes also trigger responses from care systems, such as those providing palliative care. Show more