Clinical Ethics Consultation during the First COVID-19 Lock Down in France: The “Commitment Model”: Balancing General Questions and Individual Cases

Abstract

During the first outbreak of COVID-19, the French governmental advisory council on bioethics suggested the need to support healthcare providers with ad hoc "ethical support units." Several units engaged in such endeavors across the country. This article outlines some methodological considerations made by the Cochin Hospital Clinical Ethics Center (the Cec). The Cec was founded in 2002 to provide clinical ethics support services. While its approach was inspired by North American models, it was shaped by and adapted to the French context. This approach is called the "Commitment Model," as it draws upon societal engagement in all phases of its service and places the perspectives of individual patients at its core. During the first outbreak of COVID-19 pandemic, the Cec received a greater number of requests about recurring care practices or ethical guidelines and recommendations than single clinical ethics dilemmas. Through the presentation of an illustrative consultation, this article describes how, while the Cec made some adjustments to its service for the emergency situation, it preserved its case-by-case approach rather than engaging in what it calls organizational and institutional ethics. Such an approach allowed the Cec to refocus attention to individual patients and their unique circumstances and to support decision makers by the use of case-by-case, problematized, ethical reflections.