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Health Care Ethics

Introduction to Covid-19 and Health Care Workers

The unforeseen and unexpected challenges raised by the COVID-19 disease outbreak have put immense strain on medical services, all over the world. The sheer enormity of figures combined with increasing disease infectiousness has caused country-wide lockdowns around the globe's vast swaths. A group required to function as normal in these tough circumstances are the health care professionals (HCP). The consequent effect of the COVID-19 outbreak on the mental health of frontline health care workers' (HCW) is attracting valid attention (Yin et al., 2020). As these thoughts predominate in the mind, contrasted with other concerns like taking care of their family's needs, their own mental and physical health requirements, as well as demands for work and treatment, HCW 's judgment could become tainted. As their own continuous heath risk will impact clinical judgment, the risks of medical mistakes increase, and therefore the burnout risk increases. 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.

Moral and Ethical Considerations for the HCWs.

 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 (Harkin, 2020). 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.

The principle of autonomy of the patient while making decisions for the patient are usually bound by idea of the doctor and the healthcare workers providing sufficient patient education and leaving the final decision of his care to the patient(Smith et al., 2015). However, in the case of this argument, if in any particular case, the patient’s autonomy is imposing a direct danger or risk to the doctor and his life, then the principle stands not respected for the patient (Smith et al., 2015).

Looking at the idea of non-maleficence, the promise is of doing no harm to the patient by way of omission and commission both. In the case of the pandemic, it is argued that a refusal to provide care would come under doing harm to the patient by way of omission and not abiding by the principle of non-maleficence( Harkin, 2020). However, in specific cases of not having appropriate PPE and equipment for providing care to the patients while protecting themselves, it becomes difficult to draw an objective conclusion. It has been argued that this guidance goes against the moral obligations of the HCWs that they have towards their families, spouse and children. Also, a physician’s duty of care is not limitless and is determined by a number of factors such as specialty, the risk and danger of harm to the clinician himself/herself and the potential benefit of treatment to the patients (Bakewell et al., 2020). All of the factors should be taken into account while deciding on the idea of non-maleficence for both the patient and the healthcare worker as well (Orentlicher, 2018).

The idea and ethic of justice for the patients in terms of accessibility to adequate resources for the patients and getting equal access to healthcare services is based on the provision and availability of the said resources by the government. If poor availability and lack of proper equipment and PPE exists, then it becomes difficult to choose and decide who should be preferred for the provision of treatment (Orentlicher, 2018). In particular and specific cases where the HCWs refuse to provide care due to the lack of proper resources for both the HCW and patient, the onus of this blatant negation of the ethic of justice lies on the system instead of the HCW alone.

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 (Jeffrey, 2020).

Choices must be made according to the situations instead of rigid rules. 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). 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).

The Status of The Health System and The Health Care Workers

It was seen in a detailed list of 'Fallen Coronavirus Heroes' compiled by medical school professor at Harvard University, Michael C. Gibson, documents (as of March 31, 2020) the death of 119 health care workers who died of COVID-19 infections they contracted while treating an infected patient (Gössling et al., 2020). Perhaps a brief look at the news tells us several doctors and nurses are hesitant to treat COVID-19 infected patients. This can be attributed to the condition of the health system and its fallacies. The lack of safety equipment for the health care workers also gives them the right to say no for the treatment of infected patients. The number of personal protective equipment (PPE) in the Queensland state of Australia is not adequate, writes Alex Markwell, the state's Clinical Senate President. Bulgaria has witnessed a surge of practitioners stepping down, the Zimbabwean HCPs striking over the shortage of safety materials and the UK professionals have repeatedly warned that the lack of adequate safety equipment places their personal lives in danger (Schuklenk, 2020).The number is almost definitely considerably higher and, for some time to come, it is likely to increase regularly. There could be no denying that the number of deaths will be substantial among health care system professionals who are responsible for COVID-19 patients all across the globe.

In response to reports about shortage of HCPs during anticipated COVID-19 disease outbreaks, a local government of North-Rhine Westphalia, one of Germany's most populated areas, strongly contemplated implementing a draft form of mandatory healthcare service for workers (The Local, 2020). Little did doctors realize when they entered the practice that the governments intended to force them into mandatory service at some stage later down the line, just like soldiers. It is not surprising, the HCW of the world has awoken to the risks of making claims they can neither stay true to the pledge seeing them practically. The shortage of available PPE for the health care providers had been due to an accident or it is deliberately done. One would argue that healthcare professionals would be willing to accept a certain high level of risk, but in the existing crisis, the shortage of safety equipment is genuinely intentional. 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.

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 (Schuklenk, 2020). 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.

Conclusion on Covid-19 and Health Care Workers

People should be thankful to all the health care providers who can take care of COVID-19 patients, in the lack of PPE. However, we do not have any right to take it for granted that there will be health care providers available when we will need them. It will eliminate uncertainty, promote personal choices, and minimize prejudice by setting uniform procedures for HCW's in that regard. Exceptional times require more than precedent for practice. It is believed that all such steps would assist hospitals and team members in ensuring that employees and health care personnel have the greatest working conditions possible. All these measures will inspire and encourage frontline health care workers to efficiently work while saving ourselves for yet another day at the same time.

References for Covid-19 and Health Care Workers

Bakewell, F., Pauls, M. A., &Migneault, D. (2020).Ethical considerations of the duty to care and physician safety in the COVID-19 pandemic. Canadian Journal of Emergency Medicine, 22(4), 1-4.

Gössling, S., Scott, D. & Hall, C. (2020). Pandemics, tourism, and global change: A rapid assessment of COVID-19. Journal of Sustainable Tourism, 1-20.

Harkin, D. W. (2020). Ethics for surgeons during the COVID?19 pandemic.The British Journal of Surgery, 107(9), e324.

Jeffrey., D. I. (2020). Relational ethical approaches to the COVID-19 pandemic. Journal of Medical Ethics, 1-4.

Kadish., A. &Loike., J. (2020). A pandemic ethical conundrum: Must health care workers risk their lives to treat Covid-19 patients. Retrieved from https://www.statnews.com/2020/07/24/a-pandemic-ethical-conundrum-must-health-care-workers-risk-their-lives-to-treat-covid-19-patients/

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.

Orentlicher, D. (2018). The physician’s duty to treat during pandemics. American Journal of Public Health108(11), 1459-1461.

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). What healthcare professionals owe us: Why their duty to treat during a pandemic is contingent on personal protective equipment (PPE). Journal of Medical Ethics, 2020, 1-4.

Schuklenk, U., &Zolf, B. (2018).Professionalism and the Ethics of Conscientious Objection Accommodation in Medicine.In The Palgrave Handbook of Philosophy and Public Policy (pp. 609-621). Palgrave Macmillan, Cham.

Smith, M. J., & Silva, D. S. (2015). Ethics for pandemics beyond influenza: Ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response. MonashBioethics Review33(2-3), 130-147.

The Local. (2020). What's the latest on coronavirus in Germany and what do I need to know? Retrieved fromhttps://www.thelocal.de/20200303/whats-the-latest-on-coronavirus-in-germany-and-what-do-i-need-to-know

Yin, Q., Sun, Z., Liu, T., Ni, X., Deng, X., Jia, Y. & Liu, W. (2020).Posttraumatic stress symptoms of health care workers during the corona virus disease 2019 (COVID?19). Clinical Psychology & Psychotherapy, 2019, 1-22

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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