The Royal College of Physicians, backed by an array of prestigious medical professional associations, has today published new guidelines around the Ethical dimensions of COVID-19 for front-line staff.
Dr Steve Boorman was one of many authoritative contributors, participating in his role as Chair of the Faculty of Occupational Medicine’s Ethics Committee, alongside experts from the Royal College of Nursing, Royal College of General Practitioners, Faculty of Intensive Care Medicine and many others.
The guidelines aim to support clinicians across the NHS who are engaged in the response to the coronavirus pandemic and treatment of patients with COVID-19.
Among the inclusions of the report are:
Fair and equitable treatment for all
The document sets out clear and comprehensive guidelines to help practitioners across the country to achieve consistency in the management of clinical cases and ensure equality of patient treatment across every patient group. Neutrality of approach is critical to ensure everyone from any demographic receives a high and equitable standard of care, and it is important that the care of non-COVID-19 patients remains on an equal footing.
The principle of fairness is fundamental: the writers say “Fairness is often part of disaster or emergency medicine ethics and presents a useful ethical approach for clinicians to COVID-19. The principal values that inform this guidance are that any guidance should be accountable, inclusive, transparent, reasonable and responsive.”
Support for clinical decision-making
Clarity around management of difficult decisions is necessarily included in the consideration. These are not the only or majority focus of the document – although it is quite possible that media will focus in on this area above or to the exclusion of others. The guidelines stress the importance of good stewardship, guided by a doctor’s care, as being key to good ethical practice – a stake in the ground, perhaps, that makes it clear that the medical profession intends to ensure it stays fair and unbiased.
Patient wishes and those of close family or carers are given close consideration. The realities are that among some of the most at-risk groups will be those patients for whom extraordinary interventions such as ventilation may not be ideal. A ‘one size fits all’ directive on treatment is clearly not most appropriate. Continuity of the well-established and well-tested framework of Multi-Disciplinary Team (MDT) clinical decision-making is explicitly reinforced.
Protecting our healthcare workers
In the current situation, protecting doctors and healthcare workers is paramount, and the document reminds us that doctors have not only a right, but a duty, of self-protection. It is entirely appropriate therefore that current or returning clinicians in increased risk categories are deployed in lower-risk environments. For these and all front-line workers, there is a clearly stated and absolute right of access to personal protective equipment (PPE) suitable for the tasks being undertaken.
Lastly, the guidelines remind us of the importance of accountability, demanding excellent documentation by all, at every stage. This will provide a vital record enabling future audit and analysis, and it is an important support for every decision-maker.
“This document represents consensus guidance after much hard work from senior representatives of key organisations across diverse specialties. At this time, we are asking our medical workforce to work in demanding and often unfamiliar circumstances and it is vital to ensure that ethical principles are shared, understood and available to guide key decisions. Publication of this document is important, and it helps to support clinicians during this difficult response.”Dr Steve Boorman
You can read the full Ethical dimensions of COVID-19 for front-line staff at the RCP website.
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