Covid-19: clinicians need continuing professional development in ethicsBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2793 (Published 13 July 2020) Cite this as: BMJ 2020;370:m2793
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Most people place very high value on enjoying good health. Consequently, it is generally regarded as unfair that certain groups within society (such as people with disabilities ) do not enjoy the same level of good health as others. Modern societies are not supposed to privilege one conception of “the good life” over another. Each individual has the right to have his or her own conception of the good life, and having the capability to be healthy is a prerequisite for this (1).
Social justice is central to the mission of public health. A basic principle of justice is that individuals and groups should receive fair, equitable, and appropriate treatment in light of what is due or owed to them. Justice, can provide guidance on how to allocate scarce therapeutic resources in a public health crisis(2), such as the Covid 19 pandemic.
Social justice demands that we constantly question what is ethical. The poor, the old and those with disabilities - physical, sensory or intellectual - are at risk while health hazards, such as the Covid 19 pandemic, threaten the entire population. Even in times of resource constraints, the vulnerable members of society must be protected (1). Health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population without discrimination. Neglecting ( ignoring or not understanding) the needs of the vulnerable harms the whole of society by eroding public trust ( in government, public health authorities and professional groups) and undermining social cohesion.
Social justice encompasses not only a core commitment to a fair distribution of resources, but it also calls for policies, guidelines, and protocols in healthcare and social care that are consistent with the preservation of human dignity and the showing of equal respect for the interests of all members of the community. Continuous CPD in (unbiased) ethics for all clinicians, including doctors, pharmacists and nurses should ensure that all ethical deliberations take place within the context of the principles of human rights, and all policies must be consistent with applicable human rights laws (3). (It is important to be aware that some policies, guidelines etc. (consciously or unconsciously) may promote or ‘nudge’ people toward particular ethical choices).
The WHO recognises that many different ethical principles can be applied to rationing and priority-setting in health care (3). The principle of utility, suggests that resources should be used to provide the maximum possible health benefits, often understood as “saving most lives”. The principle of equity requires that the distribution of benefits and burdens be fair. Considerations of equity may lead to giving priority to: the worst-off (in terms of severity of illness), vulnerable and disabled populations, uninfected persons who are at high-risk of developing severe complications and dying if they become infected. The WHO suggest that age-based prioritization criteria should be adopted only after wide public consultation (3). Such criteria should rely on broad life stages, rather than ranking individuals based on differences of only a few years (3).
When ethical principles conflict, the appropriate balance to be struck should be determined in an open and transparent process that takes into account local circumstances and cultural values. Doctors, pharmacists and nurses who are knowledgeable and articulate will be required.
1. Euro WHO, 2016. Social justice and human rights as a framework for addressing social determinants of health
Final report of the Task group on Equity, Equality and Human Rights. Review of social determinants of health and the health divide in the WHO European Region
2. Gostin, L.O., Wiley,L.F. Public Health Ethics and Law. The Hasting’s Centre. https://www.thehastingscenter.org/briefingbook/public-health/ Accessed July 20th, 2020.
3. WHO, 2007, Ethical considerations in developing a public health response to pandemic influenza ,WHO/CDS/EPR/GIP/2007. www.who.int/csr/resources/publications/
Competing interests: No competing interests