The Importance of Hospital Ethics During a Pandemic

To mitigate the impact of COVID-19, hospitals are responding in many ways – including reviewing, refining or changing their policies and protocols. Specific issues such as restricting visitors, allocating scarce resources and protecting the most vulnerable from harm are being discussed.

These changes and discussions involve consultation with specialists, hospital leadership and – you may be surprised to learn – ethicists.

Dr. Hazel Markwell, Chair of Bioethics in the Faculty of Theology at Saint Paul University and Theology, Ethics and Policy Advisor to the Catholic Health Alliance of Canada, is among those consulting planning groups and hospitals on ethical decision making during the pandemic.

“While the clinical situation has demanded significant changes in how we respond to the virus and what mitigation strategies we use, the pandemic does not and should not change our ethical principles,” explains Markwell. “In fact, we need these more than ever during this crisis.”

During the 2003 SARS outbreak, Markwell worked as a clinical ethicist in Toronto. Following this experience, she co-authored reports that explored the unique ethical issues that arose in hospitals as they responded to SARS.

These reports proposed ethical guidelines in the event of future infectious disease outbreaks. Today, these guidelines are being discussed relative to COVID-19.

Ethical Principles Regarding Health Care Professionals and Protocols

Ethical practices and policies are integral to health care, a profession that directly impacts people’s health and well-being. Chief among these practices is the duty to care – the ethical obligation to provide care to those in need of medical assistance.

“However, while we express gratitude to those on the front line for their commitment to caring for patients,” says Markwell, “this commitment must be met with reciprocal responses from institutions and governments in ensuring the availability of personal protective equipment (PPE).”

Shortages of PPE – masks, gloves, gowns and shields – create dangerous working conditions for health care professionals. Hospitals and governing bodies have an ethical responsibility to ensure optimal safety conditions for those working with COVID-19 patients.

Another example of the need for ethical guidelines is in the creation of triage protocols. These protocols, which should be used only as a last resort, outline the criteria to follow in allocating limited resources such as intensive care beds and ventilators.

“In discussing triage guidelines, we focus on the ethical principles of respect for patients as persons, proportionality, justice, fairness, equity, utility and the common good,” explains Markwell. “These ethical considerations help to ensure that the allocation of scarce resources is determined by clinical criteria and not social factors such as age or disability.”

Ethical Principles Regarding Visitation Policies

While restricting visitors is, unfortunately, an essential part of reducing the spread of COVID-19 within institutions, these restrictions must be balanced with protecting the emotional well-being of patients and their loved ones.

“Our discussions and recommendations for visitor restrictions are grounded in the guiding ethical principles of beneficence, reciprocity, transparency, individual liberty and the common good,” says Markwell. “Visitor restriction policies should always take into account the loneliness and isolation that often result when patients are unable to have the physical presence of their loved ones when they need them most. The focus is on balancing the need to manage transmission of disease with adopting the least restrictive visitor policies possible.”

Beyond COVID-19

Just as there were lessons to be learned from our experience with SARS, COVID-19 will also shed light on ethical responses for future outbreaks.

“COVID-19 has reminded us of the fragility of human life and how we depend on each other, that we are in fact our neighbour’s keepers,” says Markwell. “We’ve seen that we are willing to alter our lives to keep ourselves and others safe. When this pandemic is over, perhaps these lessons will result in a more just and compassionate society overall, one in which we remember that we are most fully human when we care for each other.”