Updated April 8, 2020
Responding to disasters or pandemics requires extensive involvement from physicians, not only to meet immediate needs but also to ensure that care can be provided in the future as the situation evolves (Opinion 8.3, “Physicians’ Responsibilities in Disaster Preparedness and Response,” AMA Code of Medical Ethics). During times of extraordinary need, would it be appropriate to involve medical students in providing direct patient care to supplement the physician workforce?
In Opinion 9.2.1, “Medical Student Involvement in Patient Care” recognizes the value of direct interactions with patients for students’ clinical education. Opinion 9.2.1 focuses on student involvement in care through the lens of patients’ rights and, in particular, patients’ freedom to choose from whom they will receive care. Involving students in providing care without patients’ knowledge and explicit consent would contradict existing guidance. The Code neither explicitly endorses nor explicitly prohibits medical students providing clinical care in a pandemic.
Medical students who have met the objectives of their training programs and are deemed competent to graduate by their faculty have obtained sufficient knowledge and clinical experience to provide care to patients. They are ready to uphold the medical profession’s commitments to “support access to care for all people” (Principle IX, AMA Principles of Medical Ethics), to “participate in activities contributing to the improvement of the community and the betterment of public health” (Principle VII) and to “provide urgent medical care during disasters” (Opinion 8.3).
Instructors and mentors continue to owe a duty of care to these young professionals to safeguard their well-being and supervise their ongoing education. So too, it can be argued, do the institutions in which they will practice. This encompasses a responsibility, especially in situations of pandemic disease or natural disaster, to promote conditions for safe, ethically sound practice by ensuring that entering professionals:
- Participate in patient care only on a voluntary basis
- Are assigned to provide care in contexts that minimize their risk of exposure except in the most exigent circumstances
- Are provided with personal protective equipment commensurate with their risk of exposure
- Are asked to provide care only within the limits of their training
- Are appropriately supervised in the practice setting
Additional ethics guidance in a pandemic
The AMA offers an overview of foundational guidance regarding medical ethics for health care professionals and institutions responding to the COVID-19 pandemic.