Harrowing stories reported in the media describe Covid‐19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision‐making by reducing available surrogate decision‐makers for incapacitated patients, increases the emotional burdens of surrogate decision‐makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision‐making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience.

中文翻译：

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齐心协力：应对 Covid-19 大流行期间家庭聚集带来的道德挑战

媒体报道的令人痛心的故事描述了 Covid-19 肆虐家庭的情况。本文报告了在流感大流行在南加州蔓延期间遇到的这种家庭聚集现象的专业经历。我们确定了随之而来的三个伦理挑战：家庭聚集通过减少无行为能力患者的可用代理决策者来阻碍共同决策，增加代理决策者的情感负担，并加剧有色人种的健康差距和痛苦。经历家庭聚集的可能性增加。我们建议，为了应对这些挑战，扩大预先护理计划的力度，增加对代理人和家庭成员的情感支持，对无人代理的患者的道德决策发布更强有力的国家指导，在医疗机构中增加道德咨询。家庭集群动态导致冲突的发生，医疗保健专业人员更加关注影响患者护理和代孕体验的系统性和个人种族偏见和不平等。