COVID-19 Pandemic Preparation and Response
Bioethical Services of Virginia, Inc. (BSV, Inc.) has been providing consultative responses regarding the ethics of pandemic preparedness since 2007. We have worked with a number of organizations by providing educational sessions and policy development support, and we are currently working with many agencies as they make difficult ethical decisions in the face of the current coronavirus pandemic. It is common for providers in the midst of a crisis to forget that ethics support is available, but consideration of the ethical implications of our decisions is essential at this time. BSV, Inc. is available to provide case consultation services, assistance with policy development and review, and web-based educational programs for staff that can be provided while maintaining appropriate social distancing.
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A Classification of the Issues
1) Allocation (Triage of Victims/Distribution of Resources)
2) Liberty I (Quarantine, Isolation, Business Closures)
3) Liberty II (Staying on Post, Practicing Out of Expertise)
4) Fairness (Triage of Staff, Distribution of Risk)
5) Public Coordination (Maintaining/Satisfying/Defining Our Roles)
A Sampling of Broad Societal Questions
- Who should be in charge of coordinated response efforts?
- Under what conditions are mandatory quarantines ethical?
- Under what conditions are mandatory business closures ethical?
- Is it ethical for healthcare facilities forcibly to commandeer private or public business or educational infrastructure and other resources?
- Is it ethical for the pharmaceutical industry to suspend human clinical trials or otherwise adjust protocols in order to rush a vaccine into production?
- Would it be ethical to compel vaccination?
- Would it be ethical to compel vaccination with a vaccine that was developed under adjusted safety and efficacy testing protocols?
A Sampling of Facility-Specific Questions
- May staff members refuse to come to work?
- Do staff members have a right to refuse to provide services to high-risk patients?
- Do patients have a right to refuse services from high-risk providers?
- Should rotation of dangerous staffing assignments take place to reduce the risk of contagion, or should all staff members ‘take their turn’?
- Should some staffing assignments be sequestered from contagion so that non-pandemic related treatments can continue during the high-risk period?
- Should staff who have elevated risk factors be excused from hazardous duty?
- Should a staff member’s family situation impact staffing decisions?
- May staff members be “quarantined while working”?
- Do any particular staffing assignments exempt an employee from hazardous duty?
- How should we compensate those at greater risk?
- How should we prioritize recipients of PPE or vaccines?
- How should we prioritize recipients of scarce treatments (e.g. intubation)?
- When does it become appropriate to restrict visitation?
- Is it ethical to house suspected COVID-19 positive patients with known positive patients when space is limited?
A Sampling of Societal/Facility Intersecting Questions
- Should broader social considerations impact local decisions (long term goals/constituencies)
- How should admissions criteria change in the event of a local outbreak of a pandemic (acuity of need)?
- How should discharge criteria change in the event of a local outbreak of a pandemic (risk during hospitalization)?
- Does a healthcare organization have an ethical obligation to share resources with harder hit localities or facilities?
- Does a patient’s noncompliance with recommended precautions result in his/her forfeiture of the right to access scarce medical resources?
- How should we manage patients with diminished capacity who refuse to be tested for COVID-19 when the process for obtaining a court order for treatment over objections takes time?
- Do patients have a right to refuse to be tested for coronavirus, and if so, how should they be treated?
- How should organizations make decisions about and provide support to employees who are furloughed during this crisis?