Ethics Resources on COVID-19
Quick Reference Ethics Support
For informal or formal clinical or organizational ethics support during the COVID-19 pandemic, physicians can contact both Ethics NSHA and the Nova Scotia Health Ethics Network (NSHEN) by e-mailing or calling Lisbeth Witthoefft Nielsen at firstname.lastname@example.org or 902.473.1564.
Ethics issues arising during pandemics include conflicts between individual freedom and a common good, tensions regarding the duty to provide care and the right to safe working environments, and wide-ranging challenges around resource allocation. This document provides health care providers guidance on some of the ethical issues they may face during this pandemic.
Clinical and Organizational Ethics Related to Pandemics: A Short Backgrounder
This resource is intended for members of Local Ethics Teams or Ethics Committees who may find themselves asked to facilitate ethics consultations or education relating to COVID-19. This is a living document. Please send suggestions for change to Amanda.Porter@dal.ca.
Public health emergencies like pandemics challenge health care providers to move from thinking centrally of their individual patient to consideration of the community as a whole. They alter, in fundamental ways, the context in which care is delivered and the assumptions that we normally take for granted (for example, that there are enough resources for everyone to receive indicated treatments, or the primacy of liberty and autonomy). Pandemics force normally very risk-averse institutions to confront and manage unavoidable risks. Decision makers may be operating under a high degree of uncertainty, time-sensitivity, and intense emotion.
Questions that might arise for zone ethics committees/local ethics teams:
- What does the duty of care mean in a context where we don’t have the usual PPE or staffing?
- What is a reasonable departure from the standard of care? How do we determine this?
- What should I do when I feel like I’m prevented from doing the right thing, or I feel like I’m being forced to do things that I don’t agree with?
- How should I manage disagreement with colleagues about the right thing to do?
- What are the limits of patient confidentiality? What does respect for privacy require?
- What is the fairest distribution of burden or risk, both within and between teams?
- What counts as a relevant difference that might justify differential treatment?
- What level of risk is it fair to ask people to take on?
- How much better than nothing does a practice have to be in order to make it acceptable?
- What unintended harms are we generating? Can these be mitigated? Are these unintended harms overriding?
- How do we weigh very different kinds of harms against each other (e.g. physical, psychological, economic, social harms)?
- When is it fair to displace a problem onto a different part of the health system or society?
- What kinds of substitutes are acceptable?
- Should we use family members to support care? Should we restrict access by family members?
- How and to whom should limited resources be allocated (or reallocated)?
- What decisions should be left to individual health care providers and what kinds of decisions should be decided at a higher level of administration?
- How does the environment in which I’m providing care affect the standard of care?
- Whose interests are being represented in decision making? Whose interests aren’t being represented?
- Will proposed changes exacerbate existing inequalities?
- What social supports should be made available to health care providers and administrators to support them in managing and living through this ‘marathon’?
Hastings Centre Report, Ethics Resources on the Corona Virus https://www.thehastingscenter.org/ethics-resources-on-the-coronavirus/
Joint Centre for Bioethics, Stand on Guard for Thee: http://www.jcb.utoronto.ca/people/documents/upshur_stand_guard.pdf
National Collaborating Centre for Health Public Policy, Public Health Ethics: Selected Resources Ethics in a Pandemic: https://www.ncchpp.ca/docs/EthicsPandemicLiteratureReview_En.pdf
New England Journal of Medicine (Collection of resources on COVID-19) https://www.nejm.org/coronavirus?query=RP
World Health Organization. 2020 (February 27). Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19): https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf