Ethics and the Coronavirus Pandemic Essay

Introduction

The public health measures implemented during the COVID-19 pandemic have raised questions regarding their necessity, effectiveness, and impact on individuals and society. The unprecedented urgency and pressure on the national healthcare system have caused a need to review and bypass some of the regular procedures, introducing immediate solutions in rapidly changing conditions (1). Sharing authority to implement public health measures between federal, state, and local governments has led to conflicts over jurisdiction and caused an uneven distribution of medical supplies and access to public health measures (2). The argument on whether the protective measures were ethically and legally appropriate is an ongoing discussion that challenges the current understanding of public safety and civil rights.

Ethical issues of healthcare in different settings

Caring for individual patients in a hospital setting requires healthcare providers to follow the ethical guidelines in the relevant codes of ethics. For example, the British Medical Association (3) provides a comprehensive set of guidelines for ethical and legal conduct to be followed by medical professionals. These guidelines include respecting autonomy, pursuing non-maleficence, and maintaining patient confidentiality while prioritizing the patient’s best interests.

The autonomy principle states that patients have the right to take part and have a final word in the decision-making process regarding their medical treatment. However, while patients are typically encouraged to exercise this right, their medical conditions and the availability of services and resources may limit patients’ decision-making capacity (4). These boundaries have been strengthened during the pandemic, challenging the concept of shared decision-making, for example, by questioning the morality of refusing CPR on COVID-19-positive patients (1). In these conditions, the healthcare providers’ duty to maximize benefits and minimize harm while preserving patients’ confidentiality becomes the primary guideline.

Ethical issues during a national public health threat

Caring for the general public during a national crisis requires distributing limited resources. Hospital beds, ventilators, and personal protective equipment may be limited, as was demonstrated by the disjointed response to the epidemic in the US (2). Healthcare providers may face difficult decisions about allocating resources fairly, based on factors such as age, the severity of illness, and the likelihood of survival. A central ethical issue in the public health area is the relationship between individual freedom and the well-being of society (3). Some patient rights, including data privacy, principle for autonomy, and freedom of movement, may be infringed on to limit the spread of the disease.

Comparison of the settings

In summary, while both settings involve ethical considerations related to autonomy, beneficence, non-maleficence, confidentiality, and justice, the focus and scope of these ethical issues are different. Hospital treatment focuses on individual care, while public healthcare threat conditions involve considerations related to population health and public health interventions. Hospital care can infringe on specific patients’ rights to ensure their well-being. However, a public health threat may require sacrificing the best interests of some individuals to mitigate the public health risks. While the former aims to maximize the individual patient benefit, the latter prioritizes the public good.

Ethical and legal controversy of the COVID-19 protective measures

The ethical dimension of the COVID-19 protective measures challenges the established philosophical basis of patient care. Codes of ethics, including the one by the British Medical Association (3), prioritize patients’ best interests but oblige providers to recognize public health safety. Global crises lead to a conflict between consequentialism and deontological moral theories, where one prioritizes the outcome and the other urges to question the morality of individual acts (5). Kant’s categorical imperative, for example, obliges medical providers to obtain informed consent for any actions done to a patient, even if accepting a refusal jeopardizes public health (5). It is impossible to disengage moral considerations from legal rules that protect patients’ right to informed consent via 42 CFR § 482.13 (6). These conditions make the question of the restrictive measures’ validity ambiguous, challenging the existing healthcare framework and requiring the development of a more flexible system.

Conclusion

The ethical and legal implications of the COVID-19 protective measures require a deep re-evaluation of the existing global and national healthcare framework. The critical conditions made the government and healthcare providers choose between infringing on patients’ rights and jeopardizing public health. The differences between individual hospital care and public healthcare further complicated the issue by providing conflicting moral and legal obligations.

References

Kramer JB, Brown DE, Kopar PK. Ethics in the time of coronavirus: Recommendations in the COVID-19 pandemic. J Am Coll Surg. 2020 Apr;230(6): 1114–1118.

Kettl DF. States divided: The implications of American federalism for COVID‐19. Pub Adm Rev. 2020;80(4): 595–602.

British Medical Association Ethics Department. Medical ethics today: The BMA’s handbook on ethics and the law. 3rd ed. West Sussex: John Wiley & Sons, 2012

Johnson SB, Butow PN, Kerridge I, Tattersall, MHN. Patient autonomy and advance care planning: A qualitative study of oncologist and palliative care physicians’ perspectives. Sup C Canc. 2018;26(2): 565–574.

Wilkinson D, Herring J, Savulescu J. Medical ethics and law: A curriculum for the 21st century. 3rd ed. Edinburgh: Elsevier; 2020.

Code of Federal Regulations 2023 § 482.13.