Workforce Ethical Dilemmas in times of COVID-19

 

 As Angela started her car, a thought crossed her mind on when she gets home, will she be greeted by her family?

It was a disturbing thought and so she set it aside trying not to dwell on it. Why would they not? They have been always ready to greet her with a hug as soon as she arrived from her hectic hospital duty that almost left her lifeless.

What will be different this time? She imagined her two year old Sally hugging her,  and  her husband John offering to park her car and make her coffee. She reassured herself nothing would be different and continued to drive.

These are the thoughts and emotions of our healthcare workforce as they are working on the frontlines in the COVID-19 settings in the hospitals. While we are grateful for their dedicated service, some part of us is concerned if they are carriers for the virus, infecting the family when they get home. We are privy to the universal truth that the personal protective equipment as in gown, gloves, N95 respirator plus a face shield/goggles etc. are scarce. What does that leave our loved ones with? An exposure to the risk of contracting the virus at the hospital? Will they be carrying it back home?

Cases are reported across the world around growing discrimination due to heightened fears and misinformation. Driven by authentic information, ethical behavior and health literacy, there is an urgent need to counter such prejudices and show empathy to these “warriors”.

Yet another situation seen around ethical concerns is around resource allocation. During medical emergencies, it’s important to ensure that ethically appropriate treatments are delivered. In face of scarcity of resources in treatment of COVID-19 patients and shortages of life-saving equipment including ventilators and medications; healthcare personnel often face an ethical dilemma and are forced to make difficult choices for appropriate allocation of these limited health resources. In Italy, the Italian College of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) has formulated the guidelines¹ for the benefit of tackling such ethical challenges.

Recently World Health Organization (WHO) has established an international Working Group on Ethics & COVID-19 in order to develop advice² on key ethical questions that member states need to address.  Let’s map these to PMI’s Code of Ethics and Professional Conduct and see how they fit.

The Code of Ethics and Professional Conduct by Project Management Institute with its four values (Responsibility, Respect, Fairness and Honesty) are all-inclusive and can be applied to any domain and situations. We urge readers to review these and keep themselves informed.

We; as citizens; have a responsibility to ourselves and others to recognize these challenges that our near and dear ones who are front-ending the COVID-19 patients are facing. Let’s all be empathetic, responsible, respectful, honest and fair towards them and spread the word of ethical behavior in face of these challenges.

Angela reached home to find Sally and John waiting for her with basket full of flowers that they were eager to shower on their “brave” mother/wife. Angela’s eyes were wet with tears as she approached her home, facing another ethical dilemma – As much as she wants to shower her family members with hugs and kisses, as much as she’s aware of the risk that she is exposing them to. If you were Sally, what would you do?

References and helpful links

1. CLINICAL ETHICS RECOMMENDATIONS FOR THE ALLOCATION OF INTENSIVE CARE TREATMENTS, http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf
2. International working group on Ethics & COVID-19 - https://www.who.int/news-room/detail/20-03-2020-who-has-established-an-international-working-group-on-ethics-covid-19
3. PMI’s Ethical Decision-Making Framework - https://www.pmi.org/-/media/pmi/documents/public/pdf/ethics/ethical-decision-making-framework.pdf?v=1b7ea95c-6b50-4aad-9ce1-3c953efd2858&sc_lang_temp=en
4. PMI’s Code of Ethics and Professional Conduct  https://www.pmi.org/-/media/pmi/documents/public/pdf/ethics/pmi-code-of-ethics.pdf?v=5b0f0983-6467-4d7d-9aae-577fbac4d4b3&sc_lang_temp=en
5. Note: You can find a rich set of Ethics resources such as the PMI Code of Ethics and Professional Conduct, Ethical Decision Making Framework, Ethics-related Tools, etc., in many world languages at http://www.pmi.org/ethics.

Names are changed to protect identity