Ethics

What do health care organizations owe doctors battling COVID-19?

Physicians around the world have embraced their ethical duty to care for patients during the COVID-19 pandemic despite significant danger to themselves. But as ICUs have filled up and personal protective equipment has become scarce, many on the front lines have wondered what ethical obligations their employers have to support and protect them.

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The AMA has created an ethics resource page, "Obligations to protect health care professionals,” that offers expert advice on the duties health care institutions have to their workers in a pandemic. Citing numerous opinions from the AMA Code of Medical Ethics, as well as reports by the AMA Council on Ethical and Judicial Affairs, the page provides a comprehensive guide summarizing the responsibilities of health care institutions in a variety of contexts.

More broadly, the AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 pandemic. Learn more at the AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical Ethics, JAMA Network™ and AMA Journal of Ethics®, and consult the AMA’s physician guide to COVID-19.

Finding commonality in crisis

“For the most part, the Code speaks directly only to physicians, but the duty on health care institutions is implicit because if physicians are required to uphold their obligations, then somebody has to make it possible for them to do that,” said Elliott Crigger, PhD, director of ethics policy at the AMA.

Drawing on opinion 11.1.1, “Defining Basic Health Care,” and opinion 11.1.2, “Physician Stewardship of Health Care Resources,” as well as a 2011 CEJA report on continuing medical education, the resource page notes that institutions’ obligations derive from the fact that medicine, at its core, is a moral activity.

In addition, citing a 2018 CEJA report and its corresponding Code opinion 11.2.6, "Mergers between Secular and Religiously Affiliated Health Care Institutions," the resource page adds that all health care institutions have several fundamental commitments: fidelity to mission, service to patients, service to the community and institutional stewardship.

“All of these entail an institutional responsibility to support front-line caregivers and provide the resources they need to enable the institution to fulfill its commitments to the community of patients,” the page says.

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3 top-level duties

The resource page notes that, in a pandemic, all health care institutions have responsibilities to their communities to:

  • Protect health care personnel by making every effort to provide adequate personal protective equipment.
  • Seek to ensure the clinical resources physicians need to collaborate on discharge plans that are safe for patients.
  • Provide counseling or other support, especially for front-line staff grappling with the stresses of trying to provide the best care possible in crisis conditions.

Read about the plea to nation from doctors fighting COVID-19: #GetMePPE.

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More help for health care leaders

"Caring for our caregivers during COVID-19" is an AMA ethics resource page with provide practical strategies to help health system leaders support of their physicians and care teams during COVID-19. Topics include workload redistribution, institutional policies, meals, childcare and pet care, personal protective equipment, attention to emotional well-being and connecting with others.

The resource page also includes a list of resources for supporting employees during the COVID-19 crisis, guidance on engaging students in the COVID-19 response and a mechanism for organizations to share their experiences caring for health care workers during the pandemic.

A separate ethics resource page, “Speaking out on issues adversely affecting patient safety in a pandemic,” summarizes physicians’ responsibility to advocate for change and clarifies that criticism offered by physicians in good faith is not disruptive behavior.