Duty versus distributive justice during the COVID-19 pandemic

Abstract

The COVID-19 pandemic exposed vulnerabilities in inadequately prioritized healthcare systems in low- and middle-income countries such as Kenya. In this prolonged pandemic, nurses and midwives working at the frontline face multiple ethical problems, including their obligation to care for their patients and the risk for infection with severe acute respiratory syndrome coronavirus 2. Despite the frequency of emergencies in Africa, there is a paucity of literature on ethical issues during epidemics. Furthermore, nursing regulatory bodies in African countries such as Kenya have primarily adopted a Western code of ethics that may not reflect the realities of the healthcare systems and cultural context in which nurses and midwives care for patients. In this article, we discuss the tension between nurses’ and midwives’ duty of care and resource allocation in the context of the COVID-19 pandemic. There is an urgent need to clarify nurses’ and midwives’ rights and responsibilities, especially in the current political setting, limited resources, and ambiguous professional codes of ethics that guide their practice.

Knowledge, Attitudes, and Preparedness for Managing Pregnant and Postpartum Women with COVID-19 Among Nurse-Midwives in Kenya

“…However, we found that nurse-midwives working in urban areas were 3.7 times more likely to have positive attitudes than those in rural areas. This may be attributed to training, access to PPE, diagnostics, and resources to manage advanced COVID-19 cases ( Shaibu et al, 2021 ). Kenya also had more COVID-19 cases in urban areas, which may have led to better awareness and confidence in caring for pregnant women with COVID-19.…”

Ethical problems among nurses during pandemics: A study from Turkey

“…According to the literature, nurses, who are at the forefront of the fight against Covid-19, experience ethical problems in many issues such as the obligation to provide care despite being at risk of infection, patient priority, and allocation of resources [18] , [19] . These problems have made the management of care more complicated, especially during the pandemic [20] , [21] .…”

“…In another, 81.4% of the nurses stated that the maximum age to be allocated scarce resources should be 84 when there are insufficient supplies, but they believed that each patient had the right to receive optimal treatment regardless of age and medical history. Meanwhile, 74.7% stated that they did not believe that they had the right to refuse to treat certain patients [18] . In such ethical dilemmas, nurses find it hard to make and implement decisions for themselves and their patients.…”

“…In a different study, nurses said that they were not considering quitting the profession despite the stress, risks, emotional burden, insufficient support, and protection at work. They reported that this was due to their strong commitment to care, but they needed a supportive environment for their needs and ethical concerns [18] . This difference may be due to nurses’ different personal and professional values, psychosocial and economic status, and working conditions.…”

The duty to care and nurses’ well-being during a pandemic

“…21 Findings from similar studies indicated that HCWs' attitudes and beliefs about pandemics influence their willingness to work. 22,23 During the current global public health crisis caused by the rapid spread of the SARS-CoV-2 virus, priority-setting dilemmas 24 and ethical concerns due to the scarcity of resources 20,25 have been reported among nurses and HCWs. A recent study aiming to explore the ethical dilemmas of Palestinian HCWs during the early COVID-19 pandemic 26 found that almost 25% of surveyed HCWs were not willing to work during the pandemic.…”