Covid-19: balancing personal risk and professional duty

The covid-19 pandemic is a global health and societal emergency123; doctors and healthcare workers will stand together on the front line making life and death decisions at personal risk. Together we shall endure this challenge, relying on our medical professionalism.

The ancient oath of Hippocrates4 bound physicians to act for patients’ benefit and to do no harm. Today the principles of medical professionalism—the primacy of patient welfare, patient autonomy, and social justice5—underpin public trust6 and our professional codes.7 Doctors must act in patients’ best interests, but covid-19 pneumonia death rates are highest in elderly people with comorbid disease, and life support for some will be futile.8 Transmission in hospital has led to hundreds of healthcare workers dying worldwide.89 But doctors, nurses, and healthcare workers continue to selflessly face risk to help patients and colleagues. During a pandemic, some best interests of individuals are secondary to those of society.

In partnership, doctors empower patients to make informed choices. But in law, patient autonomy does not entitle everyone to any requested treatment, regardless of advisability or scarcity of resource.10 We are under no obligation to offer treatment we consider futile, but to withhold or withdraw life support because of scarcity creates a dichotomy for the doctor between patient advocate and public servant. In a pandemic, some choices are restricted. Social justice demands that we consider the needs of all while treating an individual. In epicentres, healthcare systems overwhelmed by demand for ventilators have not had enough, and necessity has directed care to likely survivors.10 These grave decisions should be taken openly, in partnership, while recognising that uncertainty exists. Treatment delays will bring collateral harm and need later redress.

Doctors will endure this epidemic with medical professionalism, balancing personal risk and professional duty, but reciprocally, society must ensure that staff are supported, throughout the pandemic and beyond.