Making Ethical Decisions During the Coronavirus Crisis

Duty to Profession

Physicians and other healthcare providers must look out for each other, especially supporting those who are placing themselves at greater risk. Otolaryngologists, in dealing with upper aerodigestive tract disorders, will undoubtedly face high-risk patient care scenarios, perhaps without sufficient PPE.

One of the harshest ethical dilemmas during epidemics is whether it will, at some point, be necessary to consider imposing limits on the continued care of critically ill patients who aren’t expected to survive.

Among our most vulnerable resources are medical students, resident physicians, and fellows, who are often on the front line. These young physicians and physicians-to-be are our profession’s most valuable future resources, and we have an ethical responsibility to protect them as much as possible. Using specific trainee and student protocols, ensuring adequate and sufficient PPE, and placing decisions for urgent or emergency endoscopic procedures with faculty members are a few ethically solid measures. Resident-faculty teams (junior resident, senior resident, faculty member) allow for thoughtful and safe patient care discussion and decision making.

Additionally, we have a professional/ethical responsibility to adopt clinic and hospital protocols that protect the staff with whom we work and for whom we may be primarily responsible. Not only are staff valuable members of the team, but they also have family and friends who should not be unnecessarily exposed to greater risk.

As the pandemic progresses, would non-critical care physicians and specialists playing a role in critical care units be considered an ethical patient care standard? With the recent relaxation of some clinical practice restrictions, it isn’t too far-fetched. Transferrable skills and experience may be required in the future, and otolaryngologists individually should consider how that might be possible with their knowledge and capabilities.

The American Academy of Otolaryngology-Head and Neck Surgery in its March 19 OTO News email presented an opportunity from the Society of Critical Care Medicine for a complimentary online training for healthcare professionals entitled “Critical Care for the Non-ICU Healthcare Professional.” These training modules are comprehensive and provide a basic knowledge foundation for how to be of assistance in critical care units if needed.

How we prioritize duty and responsibility to patients versus family and friends is a very personal decision and should be respected as such.

In addition to clinical support and oversight, there’s also the matter of emotional support. Surgeons tend to be characteristically self-reliant, but in times of sustained clinical care of seriously or critically ill patients, performed under a cloud of heightened risk using stifling or inadequate PPE, everyone can use a friend. It’s entirely conceivable that otolaryngologists might lose colleagues, family members, friends, and patients to COVID-19. We must be cognizant of the effect such losses may have on ourselves or our colleagues and make emotional support part of our ethical duty.