When I entered this profession, I did it because it was particularly difficult for a workman's son like myself. And then I had to see people die. I saw that I could never get hardened to it."Dr Rieux in Camus' The Plague 1Healthcare organizations across the nation are responding rapidly to the numerous medical, social, and legal challenges forced by the COVID-19 pandemic, in many cases altering what is considered standard of care in order to provide the best care to the most patients in the defining public health crisis of our time. 2 The urgency with which our practice decisions and organizational protocols are being reconfigured necessarily infuses considerable uncertainty into patient care and leads to sizeable variation in treatment. Being instructed to "just do the best you can," while understandable in the current situation, is a suboptimal alternative to carefully considered and systematically enacted guidelines for action. 3 An ethically sound framework has been outlined in the Hastings Center's 3-tiered approach to a pandemic; namely, the duty to plan, the duty to safeguard, and the duty to guide. 4 Furthermore, the landmarks proposed by the American College of Surgeons of transparency, advocacy, and commitment to support all those affected directly or indirectly clarify a way forward. 5 With these concepts in mind, we examine and provide recommendations for several of the most pressing ethical challenges of the novel coronavirus (COVID-19) pandemic.

No abstract

Objectives: A cornerstone of our healthcare system’s response to the coronavirus disease 2019 pandemic is widespread testing to facilitate both isolation and early treatment. When patients refuse to undergo coronavirus disease testing, they compromise not only just their own health but also the health of those around them. The primary objective of our review is to identify the most ethical way a given healthcare system may respond to a patient’s refusal to undergo coronavirus disease 2019 testing. Data Sources: We apply a systematic approach to a true clinical case scenario to evaluate the ethical merits of four plausible responses to a patient’s refusal to undergo coronavirus disease testing. Although our clinical case is anecdotal, it is representative of our experience at our University Tertiary Care Center. Data Extraction: Each plausible response in the case is rigorously analyzed by examining relevant stakeholders, facts, norms, and ethical weight both with respect to individuals’ rights and to the interests of public health. We use the “So Far No Objections” method as the ethical approach of choice because it has been widely used in the Ethics Modules of the Surgical Council on Resident Education Curriculum of the American College of Surgeons. Data Synthesis: Two ethically viable options may be tailored to individual circumstances depending on the severity of the patient’s condition. Although unstable patients must be assumed to be coronavirus disease positive and treated accordingly even in the absence of a test, stable patients who refuse testing may rightfully be asked to seek care elsewhere. Conclusions: Although patient autonomy is a fundamental principle of our society’s medical ethic, during a pandemic we must, in the interest of vulnerable and critically ill patients, draw certain limits to obliging the preferences of noncritically ill patients with decisional capacity.

No abstract