Why COVID-19 provided a timeless lesson in ethics

The responsibility to show up for patients, often referred to as the duty to treat, is an ethical obligation in medicine. But in the midst of a pandemic, it can be difficult to meet because of the added obligation to protect themselves and their patients from infection when there is a shortage of personal protective equipment (PPE).

A webinar, “Ethics and Equity in Standards of Care in Crisis,” produced by Front line project– the Centers for Disease Control and Prevention’s national training collective for infection prevention and control – featured a presentation by Matthew Wynia, MD, MPH, professor of medicine and public health and director of the Center for Bioethics and Humanities of the University of Colorado.

WADA Fellow Dr. Wynia placed the topic of infection control in the broader context of crisis care standards and outlined key ethical issues that should be a priority for physicians during a disaster response. The presentation was followed by a discussion of infection control guidelines under crisis standards, with a particular focus on staffing and PPE shortages.

Unless you’re doing any clinical work, you’ve almost certainly operated to crisis care standards at some point during the COVID-19 pandemic, Dr. Wynia noted. At the start of the pandemic, for example, doctors had to adopt standards of care for PPE.

“Reusing N95 or surgical masks is clearly not normal care,” he said. “Before this pandemic, that would have been essentially unthinkable – and now we do it all the time.”

This highlights four realities that underscore how complicated and flawed medical ethics can be in disaster response:

In fact, standards of care do not change during times of resource scarcity. The legal standard is that you cannot be held responsible for doing something that is not possible to do, an idea also taken up in medical ethics. In other words, you don’t have to do anything impossible.

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Ethical principles will not always provide answers on rationing. “We can’t just make decisions based on utilitarian calculation,” Dr. Wynia said, noting that physicians learn to look to the ethical principle for guidance.

Its four components are autonomy, beneficence, non-maleficence and justice. The challenge is that ethical principlism rarely provides a clear answer. The reason is that its principles often conflict with each other.

“That’s why ethical dilemmas arise — because you have a situation where you can’t optimize all of your key ethical principles,” Dr. Wynia said. “You have to choose some that will exceed the value of the others.”

Equity is important– even trying to maximize the number of lives saved. When rolling out vaccines, public health authorities have sometimes prioritized older populations over historically marginalized people.

“The effective and rapid deployment of vaccinations could justify it, knowing that we will exacerbate inequalities.” says Dr. Wynia. “But it will be short-term, and it’s the easiest way to get vaccines to those most at risk.”

Making local decisions requires processes, not just rules. “What we are trying to do here is really difficult. We draw lines on who gets what in a very granular world,” Dr. Wynia said. “There are very few decisions we’ve made that we haven’t had to review.”

Learn more about how the COVID-19 pandemic has raised new questions about medical right and wrong.

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Project Firstline is a collaboration of dozens of national, state, and local healthcare and public health organizations, including the AMA, who have come together to provide infection control training to millions of healthcare workers. frontline American healthcare and public health personnel. .

His Resources include educational videos, a training facilitator toolkit, web buttons and social media graphics, print materials, and online events. There are also a number of partner resourceswhich include helpful additional videos, webinars and podcasts.

Additionally, Project Firstline has several mods on the AMA Ed Hub™, covering everything from infection control and virus basics to injection safety and hand hygiene.

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