• Internal Code :
  • Subject Code : HLSC220
  • University :
  • Subject Name : Nursing

Health Care Ethics

Introduction to The Ethical Dilemmas of HCW

COVID-19 as a pandemic has exposed a lot of fallacies in our healthcare system in terms of availability, accessibility and affordability of healthcare services for everyone. It has imposed a huge burden on the healthcare resources and its sheer volume and magnitude of virulence has led to the countries worldwide imposing lockdowns (Schuklenk, 2020). One very important and specific group of people expected to work tirelessly in this situation and even in this lockdown is the healthcare workers (HCWs). They are expected to provide for and care for patients worldwide in all kinds of emergency situations and conditions even though, they are at a risk of infection themselves because of the pandemic (Menon et al., 2020). The associated greater risk of infections and virulence associated with the disease and the lack of effective personal protective equipment leads to a moral question of whether the healthcare workers should risk their lives for treating COVID 19 patients or not (Menon et al., 2020). This essay will discuss the options healthcare workers have in dealing with issues of personal safety and care and will show and reason why they ought to be able to refuse care.

What Do the Healthcare Workers (HCW) Owe Us?

As patients in a crisis like this, we expect the healthcare workers to provide us with healthcare and we depend on their services in terms of doctors and nurses to provide professional and specialist care that no one else can provide. If we do not have sufficient doctors in our local hospital, it is practically not possible to go somewhere else to get the specialist care required. The doctors in the medical oaths they take in their graduation ceremonies base their idea of doing public good based on the World Medical Association’s Geneva declaration. Initially, doctors had promised to provide care to patients as a part of emergency care without asking any questions. This continued up until 1994, after which this clause in the document was changed (Jeffrey, 2020).

Also, often argued against giving choice to HCWs is the notion that healthcare workers when choosing the profession have made their choice and given a silent and implied consent to take risks and accepted the deal their profession has made with the society as a part of their moral obligation. The reasons often cited that the doctors pay for this transaction include their monopoly in the profession associated with information asymmetry and high salaries and high standing in the society (Giubilini, 2016). Also, often quoted is the fact that during the HIV pandemic, when infection meant death, most doctor bodies and organisations in the countries has declared it compulsory for healthcare workers to provide their services. Similarly, COVID-19’s much lower risk of mortality should settle this and make it easier (Schuklenk, 2020). But, that’s not true.

The situations cannot be compared as with the HIV pandemic, the outcome was predicated based on the availability of the PPE kits for the HCWs. So, if the healthcare workers followed effective universal precautions and used the PPE kits, the chances of them getting infected with HIV would be reduced remarkably to almost negligible which is so not the case with COVID-19. The situation is strikingly different in most countries where there is no availability of PPE for most HCWs and if available, the nature of the virulence and spread of the disease make it impossible to ensure a lower spread of infection or decreased virulence (Schuklenk, 2020). Nothing definite can be said or anticipated in the case of COVID-19.

Status of The Healthcare System

Most regimes in the world have hollowed out their healthcare systems and resources so much so that there is a complete lack of availability of proper ICU facilities, ventilators, personal protective equipment and other resources in order to handle the COVID-19 situation. Most countries are facing a severe shortage of equipments, facilities and availability of PPEs as well. But, the expectation is that the doctors should and must fulfil their obligation of providing services in risky situations like these and in turn, risk their own lives and their families as well. A very good argument painted in support of this is the idea of calling those doctors and nurses – heroes. By celebrating this so-called heroism, which is actually a severe risk and sacrifice taken by doctors worldwide, the question and focus is being taken away from the fact that this situation could have been avoided completely in the first case (Kramer et al, 2020). Only if the governments and the healthcare systems were equipped enough to tackle the shortage and lack of resources, would we be in any situation to force or make it a moral obligation on the healthcare workers to compulsorily provide their services to COVID-19 patients.

The Healthcare Workers’ Moral Obligation to Provide Care

Another argument related to ethical and moral obligations of the HCWs in providing care to COVID-19 patients arises from the four principles of ethics followed by the medical world namely justice, autonomy, nonmalificence and beneficence. There exist a strong argument in the bio-ethics, especially beneficence for recognition of a compulsion and obligation by the HCWs to provide care during the pandemic specifically the intensive care unit staff and other staff specialized in critical care (Furlong, 2018). However, this argument does not take into account the idea of factors like risks to the HCW and his/her family, duties of the HCWs towards other patients and family caregiving responsibilities. So, it becomes difficult to establish a blanket rule about the scope and limit of the moral obligations expected from the healthcare worker and hence, some caution and precaution should be practiced while translating such an obligation forced upon the HCWs by virtue of the principles of ethics into compulsory, enforceable duties (Gillon, 2015).

If we force the HCWs to provide care in cases of high risk infection spread, we risk losing the HCWs and their availability in the future for all kinds of cases including COVID-19 as well. Other factors limiting the moral obligation are that some healthcare workers engage more frequently in risky behavior and provision of patients as compared to others, thus posing very high risks to their personal safety as well. The process of caring for severely infected COVID-19 patients can lead to increased risk of infections to healthcare workers (World Health Organization, 2007). Also, some HCWs might be exposed to personal risks, fairly increased when discussed in relation to COVID-19, for example, older adults having co-morbidities or HCWs with any personal characteristics which expose them to greater risk of harm or death.

What needs to be looked at is that even within the purview of the Hippocratic ethical approach, there should and must exist some autonomy and sense of justice for the healthcare worker to decide for himself/herself if he/she wants to risk their life for that particular or specific activity of care or not (Jeffrey, 2020). This freedom from the “obligation” could either be based on their own personal conditions or due to the health system and the government’s apathy towards them in terms of provision of low resources, facilities and PPE as well.

Also, sometimes observed by many ethicists is the fact that at times, doctors and HCWs deny care to patients based on their own, personal beliefs. This denial of care is based on the doctor’s own idea of moral framework, for example- denial to do an abortion, or participate in euthanasia. The ethicists believe that nothing is rigid or hard and fast in terms of the Hippocratic ethical approach and that emotions and motivations drive the very basic idea of any morality based decision making process. Hence, choices must be made according to the situations instead of rigid rules (Giubilini, 2016). For example , the moral compulsion of doing no harm as a part of nonmalificence will and must also include “self-harm” and “self-care” for the healthcare worker who is providing care to these infectious patients of COVID-19 (Robert et al., 2020).

Doctors and other healthcare workers should likewise adjust their commitments as experts with their obligations as spouses, wives, guardians, and youngsters. The hazard to individual wellbeing from the Corona virus is highly disturbing; however the danger of tainting relatives, particularly those with a higher danger of disease, might be morally and ethically inadmissible. This argument also falls under the Hippocratic four ethical principles of doing no harm to other people (Kadish et al., 2020).

Conclusion on The Ethical Dilemmas of HCW

Health care workers’ refusal to work in a highly sensitive and emergency situation might be advocated if their wellbeing or prosperity is imperiled as a result of clinical and medical susceptibilities, for example, heart issues, diabetes, pregnancy, and such that place them at a high danger of contracting and dying from the highly infectious Corona virus, or in the event that they sensibly accept that their workplace makes an inadmissible risk by not giving them basic and essentially required personal protective equipment.

Reference for The Ethical Dilemmas of HCW

Furlong., E. (2018). Health Care Ethics. Jones & Bartlett Learning.

Gillon., R. (2015). Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. Journal of Medical Ethics41(1), 111-116.

Giubilini., A. (2016). Objection to Conscience: An Argument Against Conscience Exemptions in Healthcare. Bioethics, 31(5), 400-408.

Jeffrey., D. I. (2020). Relational ethical approaches to the COVID-19 pandemic. Journal of Medical Ethics.

Kadish., A. & Loike., J. (2020). A pandemic ethical conundrum: Must health care workers risk their lives to treat Covid-19 patients? Stat News.

Kramer, J. B., Brown, D. E., & Kopar, P. K. (2020). Ethics in the Time of Coronavirus: Recommendations in the COVID-19 Pandemic. Journal of the American College of Surgeons230(6), 1114-1118.

Menon, V., & Padhy, S. K. (2020). Ethical dilemmas faced by health care workers during COVID-19 pandemic: Issues, implications and suggestions. Asian Journal of Psychiatry51, 102-116.

Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Annals of Intensive Care10(1), 1-9.

Schuklenk, U. (2020). Health care professionals are under no ethical obligation to treat COVID-19 patients. Journal of Medical Ethics Blog.

World Health Organization. (2007). Ethical considerations in developing a public health response to pandemic influenza (No. WHO/CDS/EPR/GIP/2007.2). World Health Organization.

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