Summary
An ethically sound framework for health care during public health emergencies must balance the patient-centered duty of care—the focus of clinical ethics under normal conditions—with public-focused duties to promote equality of persons and equity in distribution of risks and benefits in society—the focus of public health ethics. Because physicians, nurses, and other clinicians are trained to care for individuals, the shift from patient-centered practice to patient care guided by public health considerations creates great tension, especially for clinicians unaccustomed to working under emergency conditions with scarce resources.
This document is designed for use within a health care institution’s preparedness work, supplementing public health and clinical practice guidance on COVID-19. It aims to help structure ongoing discussion of significant, foreseeable ethical concerns arising under contingency levels of care and potentially crisis standards of care. Its method is to
- pose practical questions that administrators and clinicians may not yet have considered and support real-time reflection and review of policy and processes;
- explain three duties of health care leaders during a public health emergency: to plan, to safeguard, and to guide; and
- offer detailed guidelines to help hospital ethics committees and clinical ethics consultation (CEC) services quickly prepare to support clinicians who are caring for patients under contingency levels of care and, potentially, crisis standards of care.
This document is not intended to be, and should not be considered, a substitute for clinical ethics consultation or other medical, legal, or other professional advice on individual cases or for particular institutions. It reflects an evolving public health emergency; references are current as of March 16, 2020…… More