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Pandemic Ethics are not just about COVID patients (Part 1)

In all the talk, emails, What’s App messages, 24 hours a day media frenzy, you might start to believe that COVID patients are the only patients.

The other patients are still there…
Hoping they won’t need medical attention – perhaps delaying too long.
Hoping they can still get the treatment they need (operations, medications, a lifesaving transplant).
Hoping they can leave hospital as soon as possible.

I have been posed or overheard three ethical dilemmas in the last 48 hours. In none of these scenarios does the patient/s have COVID-19 but all are affected by the pandemic.

  1. You’re a surgeons doing a laparotomy for bowel obstruction tonight – do you create a stoma and perhaps have the patient out of hospital soon (if they can manage with a stoma bag at home) or carry out a primary anastomosis which may mean more time in hospital before the bowel is working (but less community input with stoma care)?

  2. How do you prioritise patients in need of surgery for cancer now that theatre capacity has been given over to ICU COVID care?

  3. Should a ward restrict the mobility, using chemical or physical restraint, of wandering patients who lack capacity during COVID 19?

The last one was posed to me by a group email from the UK Clinical Ethics Network.

I performed a MORAL Balance Analysis and sent it back. What do you think of the analysis?
Missing any facts or outcomes of relevance that you think are important? Would you weigh and balance differently?

That’s ok. Using the MORAL Balance framework does not mean we will all get the same answer.
It is tool for exploring and trying to objectify the ethical problem, identifying why and where differences of conclusions might be, and helping with final decision-making and documentation - because in the end a decision must be made.

Dale